Healthcare Provider Details

I. General information

NPI: 1790892156
Provider Name (Legal Business Name): DESIREE QUIRK D/B/A LAGNIAPPE MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 COVINGTON ST SUITE C
MADISONVILLE LA
70447-9685
US

IV. Provider business mailing address

303 COVINGTON ST SUITE C
MADISONVILLE LA
70447-9685
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-1448
  • Fax: 985-845-1449
Mailing address:
  • Phone: 985-845-1448
  • Fax: 985-845-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number08068
License Number StateLA

VIII. Authorized Official

Name: MRS. DESIREE T. QUIRK
Title or Position: OWNER/SOLE PROPRIETOR
Credential:
Phone: 985-845-1448