Provider Demographics
NPI:1285023010
Name:MCA SPECIALISTS HOSPITAL, LLC
Entity Type:Organization
Organization Name:MCA SPECIALISTS HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-797-1743
Mailing Address - Street 1:1945 E 70TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5347
Mailing Address - Country:US
Mailing Address - Phone:318-797-1743
Mailing Address - Fax:318-797-7599
Practice Address - Street 1:1500 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4639
Practice Address - Country:US
Practice Address - Phone:318-797-1743
Practice Address - Fax:318-797-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014572207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty