Provider Demographics
NPI:1760891964
Name:ALL AMERICAN MEDICAL SHREVEPORT LLC
Entity Type:Organization
Organization Name:ALL AMERICAN MEDICAL SHREVEPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:504-495-9757
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1602
Mailing Address - Country:US
Mailing Address - Phone:504-495-9757
Mailing Address - Fax:985-590-5116
Practice Address - Street 1:8508 LINE AVE STE D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6131
Practice Address - Country:US
Practice Address - Phone:504-495-9757
Practice Address - Fax:985-590-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty