Provider Demographics
NPI:1205873122
Name:ODELL LLC
Entity type:Organization
Organization Name:ODELL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN ODELL
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:318-671-5303
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-0316
Mailing Address - Country:US
Mailing Address - Phone:318-671-5303
Mailing Address - Fax:318-671-5366
Practice Address - Street 1:1780 E BERT KOUNS LOOP
Practice Address - Street 2:SUITE 808
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5560
Practice Address - Country:US
Practice Address - Phone:318-671-5303
Practice Address - Fax:318-671-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 332900000X
LACRT.LT3308332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332900000XSuppliersNon-Pharmacy Dispensing Site
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies