NPIMap

Organization Active NPI

Pam Specialty Hospital of Shreveport LLC

Doing business as PAM Specialty Hospital of Shreveport South

  • Long Term Care Hospital
  • Shreveport, LA
National Provider Identifier
1942857784
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
PAM SPECIALTY HOSPITAL OF SHREVEPORT LLC
Doing business as
PAM Specialty Hospital of Shreveport South
Practice address
1541 Kings Hwy FL 10
Shreveport, LA 71103-4228
Phone
(318) 212-3200
NPI assigned
Aug 26, 2019
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anthony Misitano
Title
President
Phone
(717) 731-9660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

1541 Kings Hwy FL 10
Shreveport, LA 71103-4228

Mailing address

1828 Good Hope Rd
Enola, PA 17025-1203

Other practice location 1

2550 Kings Hwy
Shreveport, LA 71103-3922
Phone (318) 212-3200

Other practice location 2

8001 Youree Dr
Shreveport, LA 71115-2302
Phone (318) 212-6860

Other names 1

  • PAM Specialty Hospital of Shreveport South Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191024000475 LA Part A Provider - Hospital 6204168214 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942857784. Details of each certification follow.

Hospital certification: CCN 192011

Legal name
PAM SPECIALTY HOSPITAL OF SHREVEPORT LLC
Doing business as
PAM HEALTH SPECIALTY HOSPITAL OF SHREVEPORT
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jan 1, 1994
Last certification
Apr 3, 2026
Beds
24
Ownership / control type
Private (for profit)
Most recent change of ownership
Sep 30, 2019 (2 total)
Organization structure
LLCProprietary
Incorporated
Aug 19, 2019 in PA
Enrollment address
1541 Kings Hwy
FL 10
Shreveport, LA 71103-4228
Main/Primary Hospital Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Pam Health Specialty Hospital of ShreveportCCN 192011 · All quality measures
Ownership
For profit
Certified
Jan 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Beds
24

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1054451Pam Health Specialty Hospital of Shreveport1541 Kings Highway, Floor 10, Shreveport, LA 71103AccreditationDec 30, 2026

National Provider Directory

National Provider Directory

Locations

1541 Kings Hwy
Fl 10
Shreveport, LA 71103
Phone (318) 212-3200

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karick E Stober Individual Corporate OfficerVice President/Treasurer Aug 19, 2019
Anthony F Misitano Individual Corporate OfficerPresident Aug 19, 2019
Pam Cubed LLC Organization, Enola, PA LLC, For-profit, Chain home office 5% Or Greater Indirect Ownership Interest Sep 30, 2019 100%
Bobby Sisk Individual W-2 Managing EmployeeCeo Feb 23, 2026
Wells Fargo Bank, N.a. Organization, Minneapolis, MN Corporation, Financial institution 5% Or Greater Security Interest Jul 23, 2024
Brittany Misitano Individual 5% Or Greater Indirect Ownership InterestVice President/Secretary Aug 19, 2019 73.5%
Corporate Officer Aug 19, 2019
Pam Cubed Specialty Hospitals LLC Organization, Enola, PA LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Sep 30, 2019 100%

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 42

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1942857784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 GOOD HOPE RD",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170251203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY FL 10",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-212-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2550 Kings Hwy",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711033922",
            "country_code": "US",
            "telephone_number": "318-212-3200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8001 Youree Dr",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711152302",
            "country_code": "US",
            "telephone_number": "318-212-6860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAM SPECIALTY HOSPITAL OF SHREVEPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "MISITANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-731-9660"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAM Specialty Hospital of Shreveport South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.