MEDICARE: DME OF LOUISIANA 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	4504973-001	LA

General Provider Information

NPI Number	:	1780696823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME OF LOUISIANA LLC

Provider Business Mailing Address
First Line	:	107 E OAK ST
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2815
Country	:	US
Telephone Number	:	985-747-2338
Fax Number	:	985-747-2068

Provider Business Practice Location Address
First Line	:	107 E OAK ST
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2815
Country	:	US
Telephone Number	:	985-747-2338
Fax Number	:	985-747-2068

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DELANA R MAYES
Credential	:
Telephone Number	:	985-747-2338

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	08/22/2020

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Directions to “DME OF LOUISIANA LLC ” Practice Location

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