Provider Demographics
NPI:1659469799
Name:BOSSIER SURGICAL ASSOCIATES APMC
Entity Type:Organization
Organization Name:BOSSIER SURGICAL ASSOCIATES APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-746-4460
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:STE. 250
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-746-4460
Mailing Address - Fax:318-746-3389
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:STE. 250
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-746-4460
Practice Address - Fax:318-746-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035289Medicaid
LA5CV90Medicare PIN