MEDICARE: TALBERT'S MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	LA
2	335E00000X	Prosthetic/Orthotic Supplier	LA
3	332BX2000X	Oxygen Equipment & Supplies (DME)	LA
4	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	:	1689619520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBERT'S MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 580
Second Line	:
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	:	06/17/2006
Last Update Date	:	03/06/2008

Similar Medicare Providers

1215995592 — TALBERTS MEDICAL LLC
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1011 LAKE SHORE DR , SUITE 521
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1649104258 — LISA GRAYSON
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Directions to “TALBERT'S MEDICAL LLC ” Practice Location

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