Basic Information
| Provider Information | |||||||||
| NPI: | 1629558911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | B & K SUPPLY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1836 | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712731836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182516344 | ||||||||
| FaxNumber: | 3512516257 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 EZELLE ST | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182513126 | ||||||||
| FaxNumber: | 3182516257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3183815182 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD.09659R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.