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General NPI Number Information
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NPI Number | 1649260852
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Entity Type | Organization
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Legal Business Name | ACADIANA MEDICAL SUPPLY
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1201 CENTER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-6138
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Country | US
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Telephone | 337-560-5386
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 CENTER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-6138
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Country | US
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Telephone | 337-560-5386
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE NICHOLSON
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Credential |
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Telephone | 337-560-5386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2942191001
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License Number State | LA
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