Provider Demographics
NPI:1427154137
Name:CENTRAL LOUSIANA HOME OXYGEN, INC.
Entity type:Organization
Organization Name:CENTRAL LOUSIANA HOME OXYGEN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:662-578-7641
Mailing Address - Street 1:314 CUTTING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-6214
Mailing Address - Country:US
Mailing Address - Phone:662-578-7641
Mailing Address - Fax:662-578-2124
Practice Address - Street 1:577 CUTTING HORSE LANE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-578-7641
Practice Address - Fax:662-578-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04750/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0440628Medicaid
AR139110716Medicaid
MS1156140001Medicare NSC