Provider Demographics
NPI:1588036552
Name:BRFHH SHREVEPORT LLC
Entity Type:Organization
Organization Name:BRFHH SHREVEPORT LLC
Other - Org Name:UNIVERSITY HEALTH SHREVEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-675-5248
Mailing Address - Street 1:1541 KINGS HWY
Mailing Address - Street 2:RM EG-10
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-3364
Mailing Address - Fax:318-675-4369
Practice Address - Street 1:1541 KINGS HWY RM EG-10
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:318-675-3364
Practice Address - Fax:318-675-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY007202IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154847OtherPK
LA1737712Medicaid