Provider Demographics
NPI:1801056502
Name:MILTON SLOCUM MD APMC
Entity type:Organization
Organization Name:MILTON SLOCUM MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-635-5151
Mailing Address - Street 1:3300 ALBERT L BICKNELL DR
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3903
Mailing Address - Country:US
Mailing Address - Phone:318-635-5151
Mailing Address - Fax:318-635-9191
Practice Address - Street 1:3300 ALBERT L BICKNELL DR
Practice Address - Street 2:SUITE 7B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3903
Practice Address - Country:US
Practice Address - Phone:318-635-5151
Practice Address - Fax:318-635-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020179174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151977901Medicaid
LA1548570Medicaid
LA1548570Medicaid