Provider Demographics
NPI:1649573387
Name:GULF STATES MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:GULF STATES MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-364-8881
Mailing Address - Street 1:4801 ERASTE HEBERT RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0839
Mailing Address - Country:US
Mailing Address - Phone:337-364-8881
Mailing Address - Fax:337-364-8862
Practice Address - Street 1:4801 ERASTE HEBERT RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-0839
Practice Address - Country:US
Practice Address - Phone:337-364-8881
Practice Address - Fax:337-364-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies