Provider Demographics
NPI:1962461715
Name:ARK-LA-TEX MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:ARK-LA-TEX MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RESTOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-218-5531
Mailing Address - Street 1:3825 GILBERT DR
Mailing Address - Street 2:SUITE 142
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-5000
Mailing Address - Country:US
Mailing Address - Phone:318-861-5907
Mailing Address - Fax:318-861-5908
Practice Address - Street 1:3825 GILBERT DR
Practice Address - Street 2:SUITE 142
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-5000
Practice Address - Country:US
Practice Address - Phone:318-861-5907
Practice Address - Fax:318-861-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023244OtherACM
F0589OtherBC/BS OF LA
LA1544141Medicaid
1222320001Medicare ID - Type Unspecified