Provider Demographics
NPI:1770683997
Name:BRYN-FINCHER PULMONARY & CRITICAL CARE
Entity Type:Organization
Organization Name:BRYN-FINCHER PULMONARY & CRITICAL CARE
Other - Org Name:PULMONARY DISEASE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRYN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-635-0834
Mailing Address - Street 1:2551 GREENWOOD ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3905
Mailing Address - Country:US
Mailing Address - Phone:318-635-0834
Mailing Address - Fax:318-636-2331
Practice Address - Street 1:2551 GREENWOOD ROAD
Practice Address - Street 2:STE 210
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3905
Practice Address - Country:US
Practice Address - Phone:318-635-0834
Practice Address - Fax:318-636-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793761Medicaid
LA14433OtherBCBS LA
LA1793761Medicaid