MEDICARE: TALBERTS 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	335E00000X	Prosthetic/Orthotic Supplier
2	332BD1200X	Dialysis Equipment & Supplies (DME)		LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	L0729	OTHER	LA	MEDICARE SUBMITTER

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	:	1215995592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBERTS MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 580
Second Line	:	SUITE 521
City	:	LAKE CHARLES
State	:	LA
Zip	:	70602-0580
Country	:	US
Telephone Number	:	337-439-2119
Fax Number	:	337-439-2120

Provider Business Practice Location Address
First Line	:	1011 LAKE SHORE DR
Second Line	:	SUITE 521
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-9412
Country	:	US
Telephone Number	:	337-439-2119
Fax Number	:	337-439-2120

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY LOUISE TALBERT
Credential	:
Telephone Number	:	337-439-2119

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/06/2008

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Directions to “TALBERTS MEDICAL LLC ” Practice Location

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