Provider Demographics
NPI:1962970582
Name:TOTAL HEALTH FAMILY MEDICINE
Entity type:Organization
Organization Name:TOTAL HEALTH FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LETATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE-NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC
Authorized Official - Phone:318-686-3770
Mailing Address - Street 1:9435 MANSFIELD RD STE 5B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3859
Mailing Address - Country:US
Mailing Address - Phone:318-686-3770
Mailing Address - Fax:318-686-3838
Practice Address - Street 1:9435 MANSFIELD RD STE 5B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3859
Practice Address - Country:US
Practice Address - Phone:318-686-3770
Practice Address - Fax:318-686-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty