MEDICARE: MISS LULA BELL THURMAN DME SUPPLIER

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	1319060-001	LA

General Provider Information

NPI Number	:	1982620605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LULA BELL THURMAN DME SUPPLIER

Provider Business Mailing Address
First Line	:	8510 SPORTS HAVEN DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-6000
Country	:	US
Telephone Number	:	337-625-1991
Fax Number	:	337-625-1914

Provider Business Practice Location Address
First Line	:	2631 E NAPOLEON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-3707
Country	:	US
Telephone Number	:	337-625-1991
Fax Number	:	337-625-1914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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