MEDICARE: ASHLAR MEDICAL, LLC

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1306867429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLAR MEDICAL, LLC

Provider Business Mailing Address
First Line	:	816 UNIVERSITY PKWY
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457
Country	:	US
Telephone Number	:	318-352-8075
Fax Number	:	318-357-1535

Provider Business Practice Location Address
First Line	:	1908 GREENWOOD DR STE B
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-785-8766
Fax Number	:	573-785-8769

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. CYNTHIA MARIE LINVILLE
Credential	:
Telephone Number	:	573-785-8766

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/08/2011

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