Healthcare Provider Details

I. General information

NPI: 1366440695
Provider Name (Legal Business Name): BEST BUY HOMECARE OF LOUISIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 GEORGIA ST
LOUISIANA MO
63353-2743
US

IV. Provider business mailing address

3426 GEORGIA ST
LOUISIANA MO
63353-2743
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-4527
  • Fax: 573-754-4529
Mailing address:
  • Phone: 573-754-4527
  • Fax: 573-754-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateMO

VIII. Authorized Official

Name: PAUL S MCKENNA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 573-754-4527