Provider Demographics
NPI:1437241130
Name:BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA
Entity Type:Organization
Organization Name:BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-716-4100
Mailing Address - Street 1:PO BOX 38050
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-8050
Mailing Address - Country:US
Mailing Address - Phone:318-716-4000
Mailing Address - Fax:318-716-4075
Practice Address - Street 1:2120 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4015
Practice Address - Country:US
Practice Address - Phone:318-716-4000
Practice Address - Fax:318-716-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948888Medicaid
LA5D914Medicare PIN