Healthcare Provider Details

I. General information

NPI: 1316915689
Provider Name (Legal Business Name): SPECIALTY MEDICAL SUPPLY OF LA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 CYPRESS ST SUITE 13
WEST MONROE LA
71291-7319
US

IV. Provider business mailing address

3426 CYPRESS ST SUITE 13
WEST MONROE LA
71291-7319
US

V. Phone/Fax

Practice location:
  • Phone: 318-397-3800
  • Fax: 318-397-3860
Mailing address:
  • Phone: 318-397-3800
  • Fax: 318-397-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2215507-001
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2215507-001
License Number StateLA

VIII. Authorized Official

Name: MR. BAIN FOOTE
Title or Position: MANAGING PARTNER
Credential:
Phone: 318-397-3800