Healthcare Provider Details

I. General information

NPI: 1942929138
Provider Name (Legal Business Name): DURAMED, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4373 PARK TEN DR
DIAMONDHEAD MS
39525-3212
US

IV. Provider business mailing address

1015 24TH ST
KENNER LA
70062-5268
US

V. Phone/Fax

Practice location:
  • Phone: 228-333-9231
  • Fax:
Mailing address:
  • Phone: 504-467-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RICKY WALTER DECASTRO SR.
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 504-467-4057