MEDICARE: BREAST CARE SPECIALISTS AMC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1821127978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAST CARE SPECIALISTS AMC

Provider Business Mailing Address
First Line	:	820 JORDAN ST STE 210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4519
Country	:	US
Telephone Number	:	318-524-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 JORDAN ST STE 210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4519
Country	:	US
Telephone Number	:	318-687-7117
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL OFFICER
Name	:	CHRISTOPHER S. SOCKRIDER
Credential	:	MD
Telephone Number	:	318-687-7117

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/12/2024

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Directions to “BREAST CARE SPECIALISTS AMC ” Practice Location

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