Healthcare Provider Details

I. General information

NPI: 1073676714
Provider Name (Legal Business Name): JEFF DAVIS MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 N CUTTING AVE
JENNINGS LA
70546-4202
US

IV. Provider business mailing address

1338 N CUTTING AVE P.O. BOX 757
JENNINGS LA
70546-4202
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-3165
  • Fax: 337-824-3183
Mailing address:
  • Phone: 337-824-3165
  • Fax: 337-824-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4803
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. CHRISTEL DOUCET
Title or Position: BUSINESS OFFICE MANGER
Credential:
Phone: 337-824-3165