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General NPI Number Information
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NPI Number | 1336184068
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Entity Type | Organization
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Legal Business Name | DELORES BLAKESLEY
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1106 MACARTHUR DR SUITE 1
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3122
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Country | US
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Telephone | 318-448-1130
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Fax | 318-448-1044
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Provider Business Mailing Address
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Address Line | 1106 MACARTHUR DR SUITE 1
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3122
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Country | US
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Telephone | 318-448-1130
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Fax | 318-448-1044
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. DELORES A BLAKESLEY
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Credential |
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Telephone | 318-448-1130
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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 | 332BX2000X
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License Number State | LA
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