Basic Information
| Provider Information | |||||||||
| NPI: | 1689112526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUIDCO MEDICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 COVINGTON CIR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711068294 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 HOSPITAL DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711112385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182127990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 02/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | GUIDRY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2259555158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 300758 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 300758 | 01 | LA | LICENSE | OTHER |