=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003848334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUDER ENTERPRISES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4754 SHAVANO OAK SUITE 104
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-388-8642
-----------------------------------------------------
Fax | 210-492-1584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 780249
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78278-0249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-388-8642
-----------------------------------------------------
Fax | 210-492-1584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | MR. JAMES K LAUDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-388-8642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------