Provider Demographics
NPI:1598475246
Name:SYNERGY INTERNATIONAL HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:SYNERGY INTERNATIONAL HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDER
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-464-7504
Mailing Address - Street 1:5400 E TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6906
Mailing Address - Country:US
Mailing Address - Phone:318-675-1313
Mailing Address - Fax:318-675-1319
Practice Address - Street 1:5400 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6906
Practice Address - Country:US
Practice Address - Phone:318-675-1313
Practice Address - Fax:318-675-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1823007Medicaid
LA3709163Medicaid
LA1059811Medicaid
LA3902940Medicaid