Provider Demographics
NPI:1225211089
Name:MARCO A. RAMOS, M.D. APC
Entity Type:Organization
Organization Name:MARCO A. RAMOS, M.D. APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-635-2086
Mailing Address - Street 1:2800 HEARNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3934
Mailing Address - Country:US
Mailing Address - Phone:318-635-2086
Mailing Address - Fax:888-810-8142
Practice Address - Street 1:2800 HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3934
Practice Address - Country:US
Practice Address - Phone:318-635-2086
Practice Address - Fax:888-810-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015523261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346311552OtherMD NPI
LA1308731Medicaid
1346311552OtherMD NPI