Provider Demographics
NPI:1598030975
Name:WILMER ADMINISTRATIVE SERVICE
Entity Type:Organization
Organization Name:WILMER ADMINISTRATIVE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:318-425-3557
Mailing Address - Street 1:3326 WESTHEIMER ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-2061
Mailing Address - Country:US
Mailing Address - Phone:318-425-3557
Mailing Address - Fax:318-222-9194
Practice Address - Street 1:3326 WESTHEIMER ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-2061
Practice Address - Country:US
Practice Address - Phone:318-425-3557
Practice Address - Fax:318-222-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00250649251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health