Provider Demographics
NPI:1710237615
Name:MED-CONSULT, INC
Entity Type:Organization
Organization Name:MED-CONSULT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:916-730-3000
Mailing Address - Street 1:8575 FERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5677
Mailing Address - Country:US
Mailing Address - Phone:318-698-8889
Mailing Address - Fax:318-698-8893
Practice Address - Street 1:8575 FERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5677
Practice Address - Country:US
Practice Address - Phone:318-698-8889
Practice Address - Fax:318-698-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC12615261QI0500X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No291U00000XLaboratoriesClinical Medical Laboratory