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General NPI Number Information
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NPI Number | 1669772927
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Entity Type | Organization
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Legal Business Name | MERIDIAN MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1029 KEYSER AVE SUITE M2
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6239
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Country | US
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Telephone | 318-238-7350
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Fax | 318-238-7351
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Provider Business Mailing Address
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Address Line | 1029 KEYSER AVE SUITE M2
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6239
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Country | US
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Telephone | 318-238-7350
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Fax | 318-238-7351
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | DR. WILLIE JACK CORLEY SR.
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Credential | M.D.
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Telephone | 318-256-5700
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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 | 35-0012400
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License Number State | LA
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