1700180205 NPI number — DURIABLE MEDICAL EQUIPMENT OF KEITHVILLE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700180205 NPI number — DURIABLE MEDICAL EQUIPMENT OF KEITHVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURIABLE MEDICAL EQUIPMENT OF KEITHVILLE
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:
6
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:
1700180205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11038 DOMINO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEITHVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71047-8308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-775-5362
Provider Business Mailing Address Fax Number:
318-775-5362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11038 DOMINO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEITHVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71047-8308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-775-5362
Provider Business Practice Location Address Fax Number:
318-775-5362
Provider Enumeration Date:
12/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
OFFICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
318-775-5362

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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)





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