Provider Demographics
NPI:1124173232
Name:FLORIDA BLVD MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:FLORIDA BLVD MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:N
Authorized Official - Last Name:OJI
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH PROFFESIONAL
Authorized Official - Phone:337-479-0013
Mailing Address - Street 1:710 W PRIEN LAKE RD
Mailing Address - Street 2:108
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8349
Mailing Address - Country:US
Mailing Address - Phone:337-479-0013
Mailing Address - Fax:337-479-0014
Practice Address - Street 1:710 W PRIEN LAKE RD
Practice Address - Street 2:108
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8349
Practice Address - Country:US
Practice Address - Phone:337-479-0013
Practice Address - Fax:337-479-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3765864-001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment