Provider Demographics
NPI:1780614404
Name:LUANT&ODERA INC
Entity type:Organization
Organization Name:LUANT&ODERA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-298-4014
Mailing Address - Street 1:379 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2242
Mailing Address - Country:US
Mailing Address - Phone:281-298-4014
Mailing Address - Fax:281-298-8028
Practice Address - Street 1:379 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2242
Practice Address - Country:US
Practice Address - Phone:281-298-4014
Practice Address - Fax:281-298-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065860332BC3200X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160155102Medicaid
TX4697590001Medicare NSC