Provider Demographics
NPI:1841423126
Name:BOUDREAUX OLSON ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BOUDREAUX OLSON ENTERPRISES, LLC
Other - Org Name:GREAT AMERICAN SCOOTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-392-7781
Mailing Address - Street 1:403 W GRAND PKWY S
Mailing Address - Street 2:SUITE M
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8358
Mailing Address - Country:US
Mailing Address - Phone:281-392-7781
Mailing Address - Fax:281-392-7797
Practice Address - Street 1:403 W GRAND PKWY S
Practice Address - Street 2:SUITE M
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8358
Practice Address - Country:US
Practice Address - Phone:281-392-7781
Practice Address - Fax:281-392-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6420870001Medicare NSC