Basic Information
| Provider Information | |||||||||
| NPI: | 1770587537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCALTSAS | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 E BERT KOUNS LOOP | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187984458 | ||||||||
| FaxNumber: | 3187984474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 E BERT KOUNS LOOP | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187984458 | ||||||||
| FaxNumber: | 3187984474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 01/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 11943R | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 189185501 | 01 | TX | TEXAS MEDICAID | OTHER | 1053315846 | 01 | LA | GROUP NPI NUMBER | OTHER | 1684953 | 05 | LA | MEDICAID | 130015368 | 01 | LA | RAILROAD MEDICARE | OTHER |