NPI | 1528194537 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHNNY COX Executive Director 318-932-3177 |
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 | 2007-02-26 |
Last Update Date | 2007-09-11 |