Healthcare Provider Details

I. General information

NPI: 1013070945
Provider Name (Legal Business Name): DUDLEY ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 SAMFORD AVE
SHREVEPORT LA
71103-3727
US

IV. Provider business mailing address

PO BOX 13524
ALEXANDRIA LA
71315-3524
US

V. Phone/Fax

Practice location:
  • Phone: 318-459-1440
  • Fax: 318-459-1439
Mailing address:
  • Phone: 800-815-0586
  • Fax: 318-445-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ZELL DUDLEY
Title or Position: OWNER
Credential:
Phone: 318-459-1440