Provider Demographics
NPI:1245506021
Name:LOUBERTHA MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:LOUBERTHA MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUBERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-665-4270
Mailing Address - Street 1:5902 SHINNING LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2024
Mailing Address - Country:US
Mailing Address - Phone:832-665-4270
Mailing Address - Fax:713-758-0228
Practice Address - Street 1:5902 SHINNING LEAF CIR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2024
Practice Address - Country:US
Practice Address - Phone:832-665-4270
Practice Address - Fax:713-758-0228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUBERTHA MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies