Healthcare Provider Details

I. General information

NPI: 1255397030
Provider Name (Legal Business Name): COMPANION HOME MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N VIENNA ST
RUSTON LA
71270
US

IV. Provider business mailing address

PO BOX 2274
RUSTON LA
71273-2274
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-1100
  • Fax: 318-251-0702
Mailing address:
  • Phone: 318-251-1100
  • Fax: 318-251-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier37644820010
Identifier TypeOTHER
Identifier StateLA
Identifier IssuerDEPT OF REVENUE SALES TAX
# 2
Identifier1653543
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name: MR. WILLIAM LEWIS WHITTENBURG
Title or Position: OWNER PRESIDENT
Credential:
Phone: 318-251-1100