Provider Demographics
NPI:1528011673
Name:SHREVEPORT DOCTORS HOSPITAL 2003, LTD.
Entity Type:Organization
Organization Name:SHREVEPORT DOCTORS HOSPITAL 2003, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-227-1211
Mailing Address - Street 1:1130 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3908
Mailing Address - Country:US
Mailing Address - Phone:318-227-1211
Mailing Address - Fax:
Practice Address - Street 1:1130 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3908
Practice Address - Country:US
Practice Address - Phone:318-227-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA527282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1749150Medicaid
LA190115Medicare ID - Type Unspecified