Organization · NPI-2

Powell Medical Center Minististries INC

Point of Service · Shreveport, LA

NPI number1437216710
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1437216710
Entity type
Organization (NPI-2)
Legal business name
Powell Medical Center Minististries INC
Organization subpart
No
Enumeration date
Jan 3, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
305S00000X Point of ServiceL012949LAYes

Practice location

515 Pierre Ave
Shreveport, LA 71101-2445

Phone 318-221-4471 · Fax 318-221-4913

Mailing address

515 Pierre Ave
Shreveport, LA 71101-2445

Authorized official

Albert H Powell
Physician
3182214471

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