ICP LOUISIANA ACO BILLING LLC

SHREVEPORT, LA
NPI1043894231
Entity TypeOrganization
Authorized ContactRODNEY THOMASON
Authorized Official
501-406-6180
Organization Subpart ?No
Primary Taxonomy363L00000X Nurse Practitioner
Enumeration Date2021-05-12
Last Update Date2021-05-12
Business Address
ICP LOUISIANA ACO BILLING LLC
333 TEXAS ST STE 1300
SHREVEPORT, LA 71101-3783
Phone number: 855-498-6767
Mailing Address
ICP LOUISIANA ACO BILLING LLC
PO BOX 9178
RUSSELLVILLE, AR 72811-9178
Phone number: 855-498-6767
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