| Bankai Physicians LLC | |
|
1111 Line Ave Shreveport LA 71101-3841 | |
| (318) 716-4770 | |
| (318) 716-4791 |
| Full Name | Bankai Physicians LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1111 Line Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Adam Mossallati (OWNER) |
| Authorized Official Contact | 3042035754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bankai Physicians LLC Po Box 1684 Shreveport LA 71165-1684 Ph: (318) 424-6004 | Bankai Physicians LLC 1111 Line Ave Shreveport LA 71101-3841 Ph: (318) 716-4770 |
| NPI Number | 1982145157 |
|---|---|
| Provider Enumeration Date | 03/20/2017 |
| Last Update Date | 11/21/2022 |
| Certification Date | 11/18/2022 |
| Medicare PECOS PAC ID | 5294002846 |
|---|---|
| Medicare Enrollment ID | O20170601002208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982145157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | (NU) | Secondary |
| Provider Name | Adam S Mossallati |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447517974 PECOS PAC ID: 0345548574 Enrollment ID: I20160622001074 |
| Provider Name | Lucas M Moncla |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083335533 PECOS PAC ID: 6002285954 Enrollment ID: I20221215000945 |
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