Provider Demographics
NPI:1396861415
Name:CITY OF SHREVEPORT
Entity Type:Organization
Organization Name:CITY OF SHREVEPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-747-9977
Mailing Address - Street 1:PO BOX 34500
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-4500
Mailing Address - Country:US
Mailing Address - Phone:318-747-9977
Mailing Address - Fax:318-747-9994
Practice Address - Street 1:505 TRAVIS ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3042
Practice Address - Country:US
Practice Address - Phone:318-747-9977
Practice Address - Fax:318-747-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16332341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1392278Medicaid
LA590005183OtherRAILROAD MEDICARE
LA27751OtherBLUE CROSS BLUE SHIELD
LA27751OtherBLUE CROSS BLUE SHIELD