MEDICARE: NORTH LOUISIANA SURGERY CENTER

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	208C00000X	Colon & Rectal Surgery Physician

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	:	1548355266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LOUISIANA SURGERY CENTER

Provider Business Mailing Address
First Line	:	1512 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-746-7272
Fax Number	:	318-746-7212

Provider Business Practice Location Address
First Line	:	1512 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-746-7272
Fax Number	:	318-746-7212

Authorized Official
Title or Position	:	CEO
Name	:	LARRY S SASAKI
Credential	:	MD
Telephone Number	:	318-746-7272

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/21/2014

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