Provider Demographics
NPI:1962500850
Name:MINIMALLY INVASIVE SURGERY CENTER OF LOUISIANA
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE SURGERY CENTER OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-227-2121
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71164-1445
Mailing Address - Country:US
Mailing Address - Phone:318-227-2121
Mailing Address - Fax:
Practice Address - Street 1:1534 ELIZABETH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4531
Practice Address - Country:US
Practice Address - Phone:318-227-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14607R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1437263Medicaid
4E433Medicare ID - Type Unspecified
LA1437263Medicaid