Provider Demographics
NPI:1790732808
Name:VANHOY, TESS B (MD)
Entity Type:Individual
Prefix:DR
First Name:TESS
Middle Name:B
Last Name:VANHOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 OCKLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3024
Mailing Address - Country:US
Mailing Address - Phone:903-372-5697
Mailing Address - Fax:
Practice Address - Street 1:2300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2394
Practice Address - Country:US
Practice Address - Phone:318-212-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.022018207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930120774OtherMEDICARE RR
TX100636304Medicaid
LA1819433Medicaid
TXF94759Medicare UPIN
TX100636304Medicaid
930120774OtherMEDICARE RR