NPI |
1942857784 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
PAM SPECIALTY HOSPITAL OF SHREVEPORT LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
PAM SPECIALTY HOSPITAL OF SHREVEPORT SOUTH |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
1541 KINGS HWY FL 10 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
SHREVEPORT |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address State Name |
LA |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Postal Code |
711034228 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Telephone Number |
3182123200 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Enumeration Date |
8/26/2019 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Last Update Date |
1/26/2023 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Authorized Official Last Name |
MISITANO |
|
Authorized Official First Name |
ANTHONY |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official Title or Position |
PRESIDENT |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7177319660 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
282E00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
1/26/2023 |
|