MEDICARE: BOSSIER FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003032236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSSIER FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2539 VIKING DR STE 101
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2165
Country	:	US
Telephone Number	:	318-747-8100
Fax Number	:	318-747-8151

Provider Business Practice Location Address
First Line	:	2539 VIKING DR STE 101
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2165
Country	:	US
Telephone Number	:	318-747-8100
Fax Number	:	318-747-8151

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SANDY L SPEARS
Credential	:
Telephone Number	:	318-925-3339

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/22/2025

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