Provider Demographics
NPI:1144685470
Name:AMBULATORY STRATEGIES PHYSICIAN GROUP OF LOUISIANA LLC
Entity type:Organization
Organization Name:AMBULATORY STRATEGIES PHYSICIAN GROUP OF LOUISIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-282-2172
Mailing Address - Street 1:PO BOX 571617
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-1617
Mailing Address - Country:US
Mailing Address - Phone:469-282-2000
Mailing Address - Fax:469-282-2655
Practice Address - Street 1:9300 MANSFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3137
Practice Address - Country:US
Practice Address - Phone:318-629-3763
Practice Address - Fax:318-629-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care