Provider Demographics
NPI:1912118134
Name:SPECIALISTS HOSPITAL SHREVEPORT, LLC
Entity type:Organization
Organization Name:SPECIALISTS HOSPITAL SHREVEPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:318-213-3800
Mailing Address - Street 1:1500 LINE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4622
Mailing Address - Country:US
Mailing Address - Phone:318-213-3800
Mailing Address - Fax:318-213-3801
Practice Address - Street 1:1500 LINE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4622
Practice Address - Country:US
Practice Address - Phone:318-213-3800
Practice Address - Fax:318-213-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702439Medicaid
LA1702439Medicaid