Healthcare Provider Details

I. General information

NPI: 1528762952
Provider Name (Legal Business Name): DIRECT MEDICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S COLLEGE RD
LAFAYETTE LA
70503-3225
US

IV. Provider business mailing address

109 S COLLEGE RD
LAFAYETTE LA
70503-3225
US

V. Phone/Fax

Practice location:
  • Phone: 337-362-4004
  • Fax:
Mailing address:
  • Phone: 337-446-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: ABBY DOMINGUE
Title or Position: HR
Credential:
Phone: 337-446-4160