=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497013403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUIE AND LOUISE MEDICAL SUPPLIES AND SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11223 SE 214TH CT
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98031-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-981-4298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11223 SE 214TH CT
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98031-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SHAREHOLDER
-----------------------------------------------------
Name | FLORINA NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-595-6730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------