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General NPI Number Information
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NPI Number | 1629558911
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Entity Type | Organization
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Legal Business Name | B & K SUPPLY INC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 1401 EZELLE ST
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City | RUSTON
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State | LA
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Zip | 71270
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Country | US
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Telephone | 318-251-3126
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Fax | 318-251-6257
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Provider Business Mailing Address
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Address Line | PO BOX 1836
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City | RUSTON
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State | LA
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Zip | 71273-1836
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Country | US
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Telephone | 318-251-6344
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Fax | 351-251-6257
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Authorized Official
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Title or Position | SOLE OWNER
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Name | WILLIAM ALEXANDER
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Credential | MD
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Telephone | 318-381-5182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD.09659R
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License Number State | LA
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