Healthcare Provider Details

I. General information

NPI: 1558709279
Provider Name (Legal Business Name): NLA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8125 CAPTAIN MARY MILLER DR
SHREVEPORT LA
71115-2982
US

IV. Provider business mailing address

8125 CAPTAIN MARY MILLER DR
SHREVEPORT LA
71115-2982
US

V. Phone/Fax

Practice location:
  • Phone: 318-560-9901
  • Fax:
Mailing address:
  • Phone: 318-560-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GRADY HODGE
Title or Position: OWNER
Credential:
Phone: 318-560-9901