MEDICARE: CENTRAL LOUSIANA HOME OXYGEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	006021	AR
2	333600000X	Pharmacy	04750/11.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265533970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL LOUSIANA HOME OXYGEN

Provider Business Mailing Address
First Line	:	PO BOX 347
Second Line	:
City	:	BATESVILLE
State	:	MS
Zip	:	38606-0347
Country	:	US
Telephone Number	:	662-578-7641
Fax Number	:

Provider Business Practice Location Address
First Line	:	15926 BOUNDARY DR.
Second Line	:
City	:	ASHLAND
State	:	MS
Zip	:	38603-7739
Country	:	US
Telephone Number	:	662-224-8922
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERNEST L GARNER III
Credential	:
Telephone Number	:	662-578-7641

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/01/2009

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