Organization · NPI-2

Northwest La Incs, LLC

Point of Service · Shreveport, LA

NPI number1700901683
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1700901683
Entity type
Organization (NPI-2)
Legal business name
Northwest La Incs, LLC
Organization subpart
No
Enumeration date
Mar 20, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
305S00000X Point of Service11761LAYes

Practice location

4111 Metro Dr
Shreveport, LA 71109-6001

Phone 318-636-0390 · Fax 318-635-3298

Mailing address

4111 Metro Dr
Shreveport, LA 71109-6001

Phone 318-636-0390 · Fax 318-635-3298

Authorized official

Cindy S Parker
Regional Coordinator
3186360390

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