1538307822 NPI number — ACCURATE DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES,LLC

Table of content: ALLISON ANNE MAURO PSY.D. (NPI 1366782807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538307822 NPI number — ACCURATE DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES,LLC
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:
Provider Other Organization Name Type Code:
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:
1538307822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
429 WALL BLVD
Provider Second Line Business Mailing Address:
SUITE 407 1A
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-391-3193
Provider Business Mailing Address Fax Number:
504-391-3193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
429 WALL BLVD
Provider Second Line Business Practice Location Address:
SUITE 407 1A
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-391-3193
Provider Business Practice Location Address Fax Number:
504-391-3193
Provider Enumeration Date:
01/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DRIVER
Authorized Official First Name:
ROSLAND
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
504-439-1212

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  37183509 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1039438 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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