Provider Demographics
NPI:1851715122
Name:BARKSDALE AIR FORCE BASE
Entity Type:Organization
Organization Name:BARKSDALE AIR FORCE BASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE, BHOP
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:318-456-6705
Mailing Address - Street 1:243 CURTISS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6705
Mailing Address - Fax:318-456-1022
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6705
Practice Address - Fax:318-456-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100643261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)