MEDICARE: FAVORED MEDICAL SUPPLY

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	00038203	LA

General Provider Information

NPI Number	:	1487885802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAVORED MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1609 ORCHID ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 ORCHID ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7779
Country	:	US
Telephone Number	:	337-438-1645
Fax Number	:

Authorized Official
Title or Position	:	MARKETING EXECUTIVE
Name	:	MR. GABRIEL WILLIAMS
Credential	:
Telephone Number	:	337-438-1645

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	08/03/2009

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Directions to “FAVORED MEDICAL SUPPLY ” Practice Location

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