Healthcare Provider Details

I. General information

NPI: 1760988273
Provider Name (Legal Business Name): ESSENTIAL MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 MCVEA STREET
BAKER LA
70714-3518
US

IV. Provider business mailing address

3605 MCVEA STREET
BAKER LA
70714-3518
US

V. Phone/Fax

Practice location:
  • Phone: 225-681-3551
  • Fax:
Mailing address:
  • Phone: 225-681-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. KARAH DANIELLE MARTIN
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 225-349-9366