Healthcare Provider Details

I. General information

NPI: 1922109479
Provider Name (Legal Business Name): CDM MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CABUCK LANE
RAYVILLE LA
71269
US

IV. Provider business mailing address

70 CABUCK LANE
RAYVILLE LA
71269
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-3597
  • Fax: 318-728-9201
Mailing address:
  • Phone: 318-728-3597
  • Fax: 318-728-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number3731643-001
License Number StateLA

VIII. Authorized Official

Name: MISS DONNA SUE FOSTER
Title or Position: OWNER/MANAGER
Credential:
Phone: 318-728-3597