MEDICARE: DAREM MEDICAL LLC

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		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164515854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAREM MEDICAL LLC

Provider Business Mailing Address
First Line	:	11760 S HARRELLS FERRY RD STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2374
Country	:	US
Telephone Number	:	225-293-0491
Fax Number	:

Provider Business Practice Location Address
First Line	:	11760 S HARRELLS FERRY RD STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2374
Country	:	US
Telephone Number	:	225-293-0491
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DAVID O. WILLOUGHBY
Credential	:
Telephone Number	:	225-293-0491

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/26/2008

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Directions to “DAREM MEDICAL LLC ” Practice Location

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