Organization
GULF STATES MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH JAMES LEACH (MGR)
(985) 386-2169
Entity
Organization
Contact information
Practice address
1631 HIGHWAY 51, SUITE 6, N PONCHATOULA, LA 70454
(985) 386-2169
(985) 386-2171
Mailing address
1631 HIGHWAY 51, SUITE 6, N PONCHATOULA, LA 70454
(985) 386-2169
(985) 386-2171
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507113
—
LA
Enumeration date
07/30/2006
Last updated
12/03/2007
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