Organization
WEST LA VENTURES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS BURRON BOULWARE (OWNER)
(337) 239-6578
Entity
Organization
Contact information
Practice address
8422 KURTHWOOD RD, LEESVILLE, LA 71446-2200
(337) 239-6578
Mailing address
PO BOX 13524, ALEXANDRIA, LA 71315-3524
(318) 445-4477
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523577
—
LA
Enumeration date
04/10/2007
Last updated
06/19/2008
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