Basic Information
| Provider Information | |||||||||
| NPI: | 1144685470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY STRATEGIES PHYSICIAN GROUP OF LOUISIANA LLC | ||||||||
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| OtherOrganizationName: | VELOCITY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RDG | ||||||||
| Address2: | 6TH FLOOR, ATTN: ASPGLA AMBULATORY | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750383813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822000 | ||||||||
| FaxNumber: | 4692822655 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 MANSFIELD RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186293763 | ||||||||
| FaxNumber: | 3186293768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2015 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAMILTON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | BRADLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2108053212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | LA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.