MEDICARE: ARK-LA-TEX MEDICAL SERVICES, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1023244	OTHER	ACM
2	F0589	OTHER	BC/BS OF LA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962461715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARK-LA-TEX MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	3825 GILBERT DR
Second Line	:	SUITE 142
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-5000
Country	:	US
Telephone Number	:	318-861-5907
Fax Number	:	318-861-5908

Provider Business Practice Location Address
First Line	:	3825 GILBERT DR
Second Line	:	SUITE 142
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-5000
Country	:	US
Telephone Number	:	318-861-5907
Fax Number	:	318-861-5908

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN P RESTOVICH
Credential	:
Telephone Number	:	318-218-5531

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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