Provider Demographics
NPI:1144422650
Name:PANAKEIA HEALTH SERVICES, L.L.C.
Entity Type:Organization
Organization Name:PANAKEIA HEALTH SERVICES, L.L.C.
Other - Org Name:STONEWALL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-688-5416
Mailing Address - Street 1:8921 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2144
Mailing Address - Country:US
Mailing Address - Phone:318-688-5416
Mailing Address - Fax:318-415-0205
Practice Address - Street 1:960 HWY. 171 SOUTH
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078
Practice Address - Country:US
Practice Address - Phone:318-925-6660
Practice Address - Fax:318-925-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA194093OtherMEDICARE PROVIDER NUMBER