Provider Demographics
NPI:1912909912
Name:BRFHH SHREVEPORT LLC
Entity Type:Organization
Organization Name:BRFHH SHREVEPORT LLC
Other - Org Name:UNIVERSITY HEALTH SHREVEPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-626-0000
Mailing Address - Street 1:1541 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-626-0000
Mailing Address - Fax:318-675-7531
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-626-0000
Practice Address - Fax:318-675-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA142282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124387Medicaid
LA1444405Medicaid
LA1705675Medicaid
MN793527700Medicaid
IL720702002-001Medicaid
ALH0S0098NMedicaid
GA00537776XMedicaid
AR108357105Medicaid
AKHS8470PMedicaid
MS0020300Medicaid
LA1737712Medicaid
AZ026874Medicaid
IA0508374Medicaid
KY01370170Medicaid
IN100038750Medicaid
CO95012621Medicaid
AR108357105Medicaid
MI124387Medicaid
LA19S098Medicare ID - Type UnspecifiedPYSCHIATRY MEDICARE NUMBE