Provider Demographics
NPI:1265533970
Name:CENTRAL LOUSIANA HOME OXYGEN
Entity type:Organization
Organization Name:CENTRAL LOUSIANA HOME OXYGEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:662-578-7641
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-0347
Mailing Address - Country:US
Mailing Address - Phone:662-578-7641
Mailing Address - Fax:
Practice Address - Street 1:15926 BOUNDARY DR.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7739
Practice Address - Country:US
Practice Address - Phone:662-224-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR006021333600000X
MS04750/11.1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139110716Medicaid
MS0440628Medicaid
AR139110716Medicaid