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NPI Code Detail

MEDICARE: HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC

MEDICARE: HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC
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
1305S00000XPoint of Service

General Provider Information

NPI Number : 1619353802
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC
Provider Business Mailing Address
First Line : PO BOX 7312
Second Line :
City : SHREVEPORT
State : LA
Zip : 71137-7312
Country : US
Telephone Number : 318-205-4075
Fax Number : 318-754-4134
Provider Business Practice Location Address
First Line : 4571 N MARKET ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-2917
Country : US
Telephone Number : 318-934-0097
Fax Number : 318-934-0097
Authorized Official
Title or Position : CHEIF EXECUTIVE OFFICE
Name : MR. RICHARD L JACKSON
Credential :
Telephone Number : 318-205-4075
Provider Enumeration Date : 08/10/2015
Last Update Date : 08/10/2015

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Directions to “HARRIS MEMORIAL PEDIATRIC & FAMILY CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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