Healthcare Provider Details

I. General information

NPI: 1447395256
Provider Name (Legal Business Name): LOUISIANA HOME MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17943 HIGHWAY 432
CLINTON LA
70722-4027
US

IV. Provider business mailing address

POST OFFICE BOX 8189
CLINTON IA
70722-1189
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-4878
  • Fax: 225-683-4869
Mailing address:
  • Phone: 225-683-4878
  • Fax: 225-683-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS FULTON DEVALL
Title or Position: OWNER
Credential:
Phone: 225-683-4878