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General NPI Number Information
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NPI Number | 1003900341
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Entity Type | Organization
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Legal Business Name | MAGNOLIA RESPIRATORY & MEDICAL EQUIPMENT LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 235 FLORIDA AVE. SE
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-3728
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Country | US
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Telephone | 225-664-2119
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Fax | 225-664-2519
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Provider Business Mailing Address
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Address Line | 235 FLORIDA AVE. SE
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-3728
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Country | US
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Telephone | 225-664-2119
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Fax | 225-664-2519
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LESLIE S SMITH SR.
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Credential |
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Telephone | 225-664-2119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 320011100
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License Number State | LA
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