Healthcare Provider Details

I. General information

NPI: 1992921498
Provider Name (Legal Business Name): WEBSTER HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 WESTON ST
MINDEN LA
71055-3660
US

IV. Provider business mailing address

614 WESTON ST
MINDEN LA
71055-3660
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-5148
  • Fax: 318-377-2973
Mailing address:
  • Phone: 318-377-5148
  • Fax: 318-377-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0269350001
License Number StateLA

VIII. Authorized Official

Name: MR. WALTER D LEDIG
Title or Position: PRESIDENT
Credential:
Phone: 318-377-5148