Provider Demographics
NPI:1790720738
Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER SHREVEPORT
Entity type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER SHREVEPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VC FOR FINANCE AND ADM / CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMEY
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:BENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA, MS
Authorized Official - Phone:318-675-6327
Mailing Address - Street 1:1501 KINGS HIGHWAY
Mailing Address - Street 2:LSUHSC-S
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-6426
Mailing Address - Fax:318-675-6862
Practice Address - Street 1:1501 KINGS HIGHWAY
Practice Address - Street 2:LSUHSC-S
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-6426
Practice Address - Fax:318-675-6862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER SHREVEPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944947Medicaid
LA5D924Medicare ID - Type Unspecified
LA5D924Medicare PIN