Organization
NORTHEAST LOUISIANA MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNEDY DEWAYNE JONES SR. (OWNER/ADMINISTRATOR)
(318) 669-4814
Entity
Organization
Contact information
Practice address
777 N WASHINGTON ST, BASTROP, LA 71220-3003
(318) 556-2831
Mailing address
777 N WASHINGTON ST, BASTROP, LA 71220-3003
(318) 556-2831
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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