Organization Name: | MEDCONSULTANTS LLC |
NPI Number: | 1538517974 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLI BEAVERS (CREDENTIALING MANAGER) |
Mailing Address: | 2533 Bert Kouns Industrial Loop Suite 104 Shreveport |
State: | LA US |
Postal Code: | 711183158 |
Phone Number: | 3186988889 |
Fax Number: | 3186988893 |
NPI Enumeration Date: | 05/26/2016 |
NPI Last Update Date: | 05/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |