Provider Demographics
NPI:1154384535
Name:ACCUCARE MEDICAL L.L.C
Entity type:Organization
Organization Name:ACCUCARE MEDICAL L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-687-1444
Mailing Address - Street 1:9011 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6564
Mailing Address - Country:US
Mailing Address - Phone:318-687-1444
Mailing Address - Fax:318-687-1012
Practice Address - Street 1:9011 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6564
Practice Address - Country:US
Practice Address - Phone:318-687-1444
Practice Address - Fax:318-687-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
8200019OtherUNITED HEALTHCARE
LA1973157Medicaid
79007OtherBLUE CROSS BLUE SHIELD
57310OtherNORTHWOOD
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