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General NPI Number Information
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NPI Number | 1902993504
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Entity Type | Organization
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Legal Business Name | ALLEN MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 N MARKET ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-5263
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Country | US
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Telephone | 337-948-8611
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Fax | 337-948-6138
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Provider Business Mailing Address
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Address Line | PO BOX 2087
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City | OPELOUSAS
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State | LA
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Zip | 70571-2087
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Country | US
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Telephone | 337-948-8611
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Fax | 337-948-6138
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL ALDEN THIBODEAUX
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Credential | OWNER
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Telephone | 337-948-8611
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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 |
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License Number State | LA
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