Provider Demographics
NPI:1649201104
Name:ETHICUS HOSPITAL-SHREVEPORT, LLC
Entity Type:Organization
Organization Name:ETHICUS HOSPITAL-SHREVEPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOEPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-218-6411
Mailing Address - Street 1:3 RIVERWAY
Mailing Address - Street 2:SUITE 1810
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1919
Mailing Address - Country:US
Mailing Address - Phone:713-572-2222
Mailing Address - Fax:713-572-2273
Practice Address - Street 1:2105 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3105
Practice Address - Country:US
Practice Address - Phone:713-572-2222
Practice Address - Fax:713-572-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPPLIED FOR282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital