Healthcare Provider Details

I. General information

NPI: 1265533970
Provider Name (Legal Business Name): CENTRAL LOUSIANA HOME OXYGEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15926 BOUNDARY DR.
ASHLAND MS
38603-7739
US

IV. Provider business mailing address

PO BOX 347
BATESVILLE MS
38606-0347
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8922
  • Fax:
Mailing address:
  • Phone: 662-578-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number006021
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number04750/11.1
License Number StateMS

VIII. Authorized Official

Name: MR. ERNEST L GARNER III
Title or Position: PRESIDENT
Credential:
Phone: 662-578-7641