| Maureen Mcdonald Jacobs, | |
|
1541 Kings Hwy, Shreveport, LA 71103-4228 | |
| (318) 626-0000 | |
| Not Available |
| Full Name | Maureen Mcdonald Jacobs |
|---|---|
| Gender | Female |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 1541 Kings Hwy, Shreveport, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659451318 | NPI | - | NPPES |
| 049394202 | Medicaid | TX | |
| 1900117 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | AP01981 (Louisiana) | Primary |
| Entity Name | Tandem Anesthesia Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356453583 PECOS PAC ID: 0446159685 Enrollment ID: O20040107000123 |
| Entity Name | University Health Shreveport, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619443611 PECOS PAC ID: 7416207196 Enrollment ID: O20181109000875 |
| Mailing Address | Practice Location Address |
|---|---|
| Maureen Mcdonald Jacobs, 1512 W Kirby Pl, Shreveport, LA 71103-3822 Ph: (318) 626-0287 | Maureen Mcdonald Jacobs, 1541 Kings Hwy, Shreveport, LA 71103-4228 Ph: (318) 626-0000 |
Billy B Miller Iii, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 2510 Bert Kouns Industrial Loop, Shreveport, LA 71118 Phone: 318-212-5000 | |
Ms. Lisa Nicole Kellogg, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1541 Kings Hwy, Shreveport, LA 71103 Phone: 318-675-5000 | |
Kurvis Antione Davis, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 367 Carrollton Ave, Shreveport, LA 71105 Phone: 318-573-0604 | |
Brian House, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1541 Kings Hwy, Shreveport, LA 71103 Phone: 318-626-0000 | |
Benjamin R. Wisenbaker, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1541 Kings Hwy, Shreveport, LA 71103 Phone: 318-626-0000 Fax: 318-629-4833 | |
Michael Liles, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1541 Kings Hwy, Shreveport, LA 71103 Phone: 318-675-5000 | |
Kerri Annette Mullone, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1541 Kings Hwy, Shreveport, LA 71103 Phone: 318-626-0000 |