=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982087755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HRISHIKESH SAMANT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2015
-----------------------------------------------------
Last Update Date | 01/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 KINGS HWY LSUHSC
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71103-4228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-675-5982
-----------------------------------------------------
Fax | 318-675-5957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9395 MILBANK DR
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-3861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-378-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RT0003X
-----------------------------------------------------
Taxonomy Name | Transplant Hepatology Physician
-----------------------------------------------------
License Number | 7512
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 302015
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RI0008X
-----------------------------------------------------
Taxonomy Name | Hepatology Physician
-----------------------------------------------------
License Number | 302015
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------