Healthcare Provider Details

I. General information

NPI: 1215995592
Provider Name (Legal Business Name): TALBERTS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LAKE SHORE DR SUITE 521
LAKE CHARLES LA
70601-9412
US

IV. Provider business mailing address

PO BOX 580 SUITE 521
LAKE CHARLES LA
70602-0580
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-2119
  • Fax: 337-439-2120
Mailing address:
  • Phone: 337-439-2119
  • Fax: 337-439-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. MARY LOUISE TALBERT
Title or Position: OWNER
Credential:
Phone: 337-439-2119