Provider Demographics
NPI:1871550277
Name:YOUREE ASSOCIATES INC APC
Entity type:Organization
Organization Name:YOUREE ASSOCIATES INC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-629-1588
Mailing Address - Street 1:4651 CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-3535
Mailing Address - Country:US
Mailing Address - Phone:318-629-1588
Mailing Address - Fax:318-629-1589
Practice Address - Street 1:4651 CAMBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-3535
Practice Address - Country:US
Practice Address - Phone:318-629-1588
Practice Address - Fax:318-629-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5CD20Medicare ID - Type Unspecified