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General NPI Number Information
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NPI Number | 1972924363
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Entity Type | Organization
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Legal Business Name | BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 1868 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-3659
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Country | US
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Telephone | 318-459-3719
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Fax | 318-459-3980
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Provider Business Mailing Address
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Address Line | PO BOX 38050
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City | SHREVEPORT
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State | LA
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Zip | 71133-8050
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Country | US
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Telephone | 318-675-4131
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Fax | 318-675-4120
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. JAMES D DEAN
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Credential |
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Telephone | 318-675-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336N0007X
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Taxonomy Name | Nuclear Pharmacy
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License Number | PHY.005016-NU
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License Number State | LA
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