PEDIATRIC PROVIDERS OF LOUISIANA
Ambulatory Health at Hollywood Ave, Shreveport, LA

License number
Louisiana 06203R
Category
Ambulatory Health
Type
Health Service
Owner
Name: JEAN ROUSSEAU
Title: PRESIDENT
Phone: (318) 621-9600
Address
Address
4140 Hollywood Ave, Shreveport, LA 71109
National Provider ID: 1548494578
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PEDIATRIC PROVIDERS OF LOUISIANA (A PROFESSIONAL MEDICAL CORPORATION)

Shreveport, LA

Registration:
Aug 17, 1992
Addresses:
4140 Hollywood, Shreveport, LA 71109 (Physical)
C/O Jean W Rousseau, Shreveport, LA 71109 (Mailing)
State ID:
34414162D
Business type:
Business Corporation
President, Secretary/Treasurer, Director:
Dr. Jean W. Rousseau (President, Secretary/Treasurer, Director), 4140 Hollywood, Shreveport, LA 71109 (Physical)
Agent:
Jean W. Rousseau, M.d,4140 Hollywood, Shreveport, LA 71109 (Physical)

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