Provider Demographics
NPI:1528011236
Name:SJLBMB, INC
Entity Type:Organization
Organization Name:SJLBMB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-497-5921
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:NATALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70451
Mailing Address - Country:US
Mailing Address - Phone:800-497-5921
Mailing Address - Fax:
Practice Address - Street 1:302 E RAILROAD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2710
Practice Address - Country:US
Practice Address - Phone:800-497-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0589000002Medicare NSC