MEDICARE: BOSSIER SPECIALTY HOSPITAL 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	284300000X	Special Hospital	29570	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	:	1750345419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSSIER SPECIALTY HOSPITAL LLC

Provider Business Mailing Address
First Line	:	2105 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3105
Country	:	US
Telephone Number	:	318-549-2011
Fax Number	:	318-549-2077

Provider Business Practice Location Address
First Line	:	2105 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3105
Country	:	US
Telephone Number	:	318-549-2011
Fax Number	:	318-549-2077

Authorized Official
Title or Position	:	VP MANAGED CARE SERVICES
Name	:	DEBRA SUE HUFFMAN
Credential	:	MHA
Telephone Number	:	636-549-2384

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	08/22/2020

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Directions to “BOSSIER SPECIALTY HOSPITAL LLC ” Practice Location

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