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General NPI Number Information
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NPI Number | 1073627568
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Entity Type | Organization
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Legal Business Name | MARIE'S MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 775 S BONNER ST
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City | RUSTON
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State | LA
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Zip | 71270-5801
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Country | US
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Telephone | 318-255-3077
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Fax | 318-255-3242
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Provider Business Mailing Address
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Address Line | PO BOX 2174
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City | WEST MONROE
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State | LA
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Zip | 71294-2174
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Country | US
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Telephone | 318-338-3550
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Fax | 318-338-3551
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Authorized Official
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Title or Position | OWNER
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Name | MR. BLANE P MARIE
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Credential |
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Telephone | 318-338-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 370011363
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License Number State | LA
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