Provider Demographics
NPI:1053502294
Name:SIMBA VENTURES HOSPITAL LA, LLC
Entity Type:Organization
Organization Name:SIMBA VENTURES HOSPITAL LA, LLC
Other - Org Name:DOCTORS' HOSPITAL SHREVEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:PFEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-265-3115
Mailing Address - Street 1:1130 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3908
Mailing Address - Country:US
Mailing Address - Phone:318-227-1211
Mailing Address - Fax:318-678-4112
Practice Address - Street 1:1130 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3908
Practice Address - Country:US
Practice Address - Phone:318-227-1211
Practice Address - Fax:318-678-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA60652OtherBLUE CROSS
TX1749150Medicaid
TX190115Medicare PIN