Provider Demographics
NPI:1629255401
Name:NUBARI A GIMAH
Entity Type:Organization
Organization Name:NUBARI A GIMAH
Other - Org Name:NUZ DME SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NUBARI
Authorized Official - Middle Name:ABARILE
Authorized Official - Last Name:GIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-934-4112
Mailing Address - Street 1:610 MARSHALL ST
Mailing Address - Street 2:902
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3784
Mailing Address - Country:US
Mailing Address - Phone:318-934-4112
Mailing Address - Fax:318-934-4113
Practice Address - Street 1:610 MARSHALL ST
Practice Address - Street 2:902
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3784
Practice Address - Country:US
Practice Address - Phone:318-934-4112
Practice Address - Fax:318-934-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00203709332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6096310001Medicare NSC