Provider Demographics
NPI:1629577895
Name:FIRST CARE BOSSIER
Entity Type:Organization
Organization Name:FIRST CARE BOSSIER
Other - Org Name:FIRST CARE BOSSIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-925-3338
Mailing Address - Street 1:2539 VIKING DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2165
Mailing Address - Country:US
Mailing Address - Phone:318-747-8105
Mailing Address - Fax:318-747-8150
Practice Address - Street 1:2539 VIKING DR STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1611
Practice Address - Country:US
Practice Address - Phone:318-747-8105
Practice Address - Fax:318-747-8150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSSIER FAMILY MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care