Provider Demographics
NPI:1073708780
Name:ADVANCED LASER EQUIPMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED LASER EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-384-0802
Mailing Address - Street 1:1201 BRASHEAR AVE
Mailing Address - Street 2:430
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1361
Mailing Address - Country:US
Mailing Address - Phone:985-384-0802
Mailing Address - Fax:985-384-1585
Practice Address - Street 1:1201 BRASHEAR AVE
Practice Address - Street 2:430
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1361
Practice Address - Country:US
Practice Address - Phone:985-384-0802
Practice Address - Fax:985-384-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1072877Medicaid
LAH2253OtherBLUECROSS/BLUESHIELD
LA2742187-002OtherSTATE TAX ID NUMBER
LAH2253OtherBLUECROSS/BLUESHIELD