Healthcare Provider Details

I. General information

NPI: 1174509350
Provider Name (Legal Business Name): RED BALL MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MARKET ST
SHREVEPORT LA
71107-6747
US

IV. Provider business mailing address

PO BOX 7623
SHREVEPORT LA
71137-7623
US

V. Phone/Fax

Practice location:
  • Phone: 318-424-8393
  • Fax: 318-222-6104
Mailing address:
  • Phone: 318-424-8393
  • Fax: 318-222-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number09-0007047
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number4028
License Number StateLA

VIII. Authorized Official

Name: JUDITH K STORER
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 318-424-8393