Healthcare Provider Details

I. General information

NPI: 1881932408
Provider Name (Legal Business Name): DURAMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BARATARIA BLVD STE 1100
MARRERO LA
70072-3044
US

IV. Provider business mailing address

1015 24TH ST
KENNER LA
70062-5268
US

V. Phone/Fax

Practice location:
  • Phone: 504-467-4057
  • Fax: 504-467-4053
Mailing address:
  • Phone: 504-467-4057
  • Fax: 504-467-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RICKY WALTER DECASTRO SR.
Title or Position: PRESIDENT
Credential:
Phone: 504-467-4057