| NPI | 1295805299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY COX Executive Director 318-932-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 10775) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: LA 10783) |
| 305R00000X Preferred Provider Organization (Licence: LA 10793) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-09-11 |