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General NPI Number Information
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NPI Number | 1578800157
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Entity Type | Organization
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Legal Business Name | DURAMED, INC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 11135 INDUSTRIPLEX BLVD SUITE 800
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City | BATON ROUGE
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State | LA
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Zip | 70809-4114
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Country | US
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Telephone | 225-751-1224
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Fax | 225-751-1224
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Provider Business Mailing Address
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Address Line | 1015 24TH ST
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City | KENNER
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State | LA
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Zip | 70062-5268
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Country | US
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Telephone | 504-467-4057
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Fax | 504-467-4053
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICKY WALTER DECASTRO SR.
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Credential |
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Telephone | 504-467-4057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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