University Health Shreveport LLC
Organization Active NPI Certified Registered Nurse Anesthetist · Shreveport, LA
NPI 1629544622 · NPPES record last updated Dec 10, 2018
Key facts
- NPI
- 1629544622
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- UNIVERSITY HEALTH SHREVEPORT LLC
- Practice address
- 1541 Kings Hwy
Shreveport, LA 71103-4228 - Phone
- (318) 675-7636
- Fax
- (318) 675-7531
- NPI assigned
- Oct 17, 2018
- Organization subpart
- No
Authorized official
- Name
- Vernon Moore III
- Title
- Cfo
- Phone
- (318) 626-0000
Other NPIs on the same Medicare enrollment 1
Practitioners 113
-
Dustin Kade Bagley, CRNA
-
Amy M Bozeman, PA
-
Brittany Allyson Bozzell, PA-C
-
Andree Celeste Breaux, P.A.
-
Lacey Hauser Byram, P.A.
-
Brittany Ceaser, APRN
-
Nicolette Quinn Chadwell, PA-C
-
Elizabeth Chesne, PA
-
Nguyen Tran Cockrell, DNAP, CRNA
-
Elizabeth A Cole, CRNA
-
Brian Gregory Cornelius, CRNA
-
Tammy Ditta, APRN, FNP
-
Shiva Doty, PA-C
-
Trent Gerard Friedel, CRNA
-
Candace M Funderburk, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181109000875 | LA | Part B Supplier - Clinic/Group Practice | 7416207196 |
Receives reassigned benefits from 218 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bossier City, LA; Shreveport, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
1541 Kings Hwy
Shreveport, LA 71103-4228
Mailing address
1541 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 675-7636
Other names
- Ochsner LSU Health Shreveport
Other providers in Shreveport, LA
- Universal Medical Supplies & Rentals Inc
- University Health Shreveport LLC
- University Health Shreveport LLC
- University Health Shreveport LLC
- University Health Shreveport LLC
- University Health Shreveport LLC
- Unshattered Counseling Services, LLC
- Priyal Upadhyay
- Hannahjo Cheyenne Upchurch
- Uprising Addiction Center, LLC
All providers in Shreveport, LA · Certified Registered Nurse Anesthetist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.