Healthcare Provider Details

I. General information

NPI: 1063882793
Provider Name (Legal Business Name): CSS OF HAMMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19184 DR JOHN LAMBERT DR STE. 104
HAMMOND LA
70403-0936
US

IV. Provider business mailing address

19184 DR JOHN LAMBERT DR STE. 104
HAMMOND LA
70403-0936
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-7150
  • Fax: 985-542-7155
Mailing address:
  • Phone: 985-542-7150
  • Fax: 985-542-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERRY BRADLEY
Title or Position: OWNER
Credential:
Phone: 228-323-3382