Provider Demographics
NPI:1003900341
Name:MAGNOLIA RESPIRATORY & MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:MAGNOLIA RESPIRATORY & MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:225-664-2119
Mailing Address - Street 1:235 FLORIDA AVE. SE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-3728
Mailing Address - Country:US
Mailing Address - Phone:225-664-2119
Mailing Address - Fax:225-664-2519
Practice Address - Street 1:235 FLORIDA AVE. SE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-3728
Practice Address - Country:US
Practice Address - Phone:225-664-2119
Practice Address - Fax:225-664-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320011100332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1175811Medicaid
LA1175811Medicaid