Healthcare Provider Details

I. General information

NPI: 1346354859
Provider Name (Legal Business Name): MARIE'S MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BLANCHARD ST SUITE F
WEST MONROE LA
71291-7369
US

IV. Provider business mailing address

PO BOX 2174
WEST MONROE LA
71294-2174
US

V. Phone/Fax

Practice location:
  • Phone: 318-338-3550
  • Fax: 318-338-3551
Mailing address:
  • Phone: 318-338-3550
  • Fax: 318-338-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number310011435
License Number StateLA

VIII. Authorized Official

Name: MR. BLANE P MARIE
Title or Position: OWNER
Credential:
Phone: 318-338-3550