MEDICARE: ALLSTAR INTERNATIONAL MEDICAL SUPPLIES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	35976289D	LA

General Provider Information

NPI Number	:	1396961520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLSTAR INTERNATIONAL MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	1821 WOODDALE CT
Second Line	:	STE 210
City	:	BATON ROUGE
State	:	LA
Zip	:	70806
Country	:	US
Telephone Number	:	225-924-7080
Fax Number	:	225-923-3528

Provider Business Practice Location Address
First Line	:	1821 WOODDALE CT
Second Line	:	STE 210
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1535
Country	:	US
Telephone Number	:	225-924-7080
Fax Number	:	225-923-3528

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. AHAOMA BONIFACE OHIA
Credential	:
Telephone Number	:	225-924-7080

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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