Provider Demographics
NPI:1003269762
Name:HS LOUISIANA, LLC
Entity type:Organization
Organization Name:HS LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BOSELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-834-2679
Mailing Address - Street 1:3546 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:SUITE 113
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2713
Mailing Address - Country:US
Mailing Address - Phone:904-834-2679
Mailing Address - Fax:904-395-3249
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:SUITE 5-303
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:904-834-2679
Practice Address - Fax:904-395-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty