Provider Demographics
NPI:1548628399
Name:BEDFORD, ORA I
Entity type:Individual
Prefix:
First Name:ORA
Middle Name:
Last Name:BEDFORD
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 LINDA ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-5245
Mailing Address - Country:US
Mailing Address - Phone:318-635-9841
Mailing Address - Fax:
Practice Address - Street 1:3112 LINDA ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119
Practice Address - Country:US
Practice Address - Phone:318-635-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator