Provider Demographics
NPI:1316982499
Name:SHREVEPORT OXYGEN & RENTAL, LLC
Entity type:Organization
Organization Name:SHREVEPORT OXYGEN & RENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCFARLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-631-4755
Mailing Address - Street 1:5150 INTERSTATE DR., STE. 216
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109
Mailing Address - Country:US
Mailing Address - Phone:318-631-4755
Mailing Address - Fax:318-631-4211
Practice Address - Street 1:5150 INTERSTATE DR., STE. 216
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109
Practice Address - Country:US
Practice Address - Phone:318-631-4755
Practice Address - Fax:318-631-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332BX2000X
LA09-0011094332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476668Medicaid
LA5277660001Medicare ID - Type Unspecified