Provider Demographics
NPI:1427536325
Name:UNIVERSITY HEALTH SHREVEPORT LLC
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH SHREVEPORT LLC
Other - Org Name:OCHSNER LSU HEALTH SHREVEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-626-0000
Mailing Address - Street 1:1541 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-626-0000
Mailing Address - Fax:318-675-5666
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-626-0000
Practice Address - Fax:318-675-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA142282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
190098OtherMEDICARE
IA0508374Medicaid
LA190098OtherMEDICARE
CO95012621Medicaid
KY01370170Medicaid
IN100038750Medicaid
AR108357105Medicaid
LA1705675Medicaid
ALH0S0098NMedicaid
GA00537776XMedicaid
LA1737712Medicaid
AZ026874Medicaid
AKHS8470PMedicaid
MS0020300Medicaid
MI124387Medicaid
LA1444405Medicaid
IL720702002-001Medicaid
MN793527700Medicaid