MEDICARE: ST. LUKES REHABILITAION HOSPITAL

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	283X00000X	Rehabilitation Hospital	547	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225068950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKES REHABILITAION HOSPITAL

Provider Business Mailing Address
First Line	:	2140 MIDWAY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-2206
Country	:	US
Telephone Number	:	318-631-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 MIDWAY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-2206
Country	:	US
Telephone Number	:	318-631-2345
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GARY L CAIN
Credential	:
Telephone Number	:	210-493-5565

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/22/2020

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