1255382123 NPI number — PHYSICIANS CHOICE HOME MEDICAL & DIABETIC SUPPLY INC

Table of content: (NPI 1255382123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255382123 NPI number — PHYSICIANS CHOICE HOME MEDICAL & DIABETIC SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS CHOICE HOME MEDICAL & DIABETIC SUPPLY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIAN'S CHOICE HOME MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255382123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 DOCTORS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-746-6288
Provider Business Mailing Address Fax Number:
318-746-7911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2161 AIRLINE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111-3172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-746-6288
Provider Business Practice Location Address Fax Number:
318-746-7911
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIESLAND
Authorized Official First Name:
CLAUDE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER/COO
Authorized Official Telephone Number:
318-746-6288

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  080011399 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002107964 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: DME.001211 . This is a "LOUISIANA BOARD OF PHARMACY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1434558 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F8865 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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