MEDICARE: SPECTRUM PRODUCTS AND TECHNOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013926054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM PRODUCTS AND TECHNOLOGY

Provider Business Mailing Address
First Line	:	7525 HIGHWAY 71 S
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71302-9116
Country	:	US
Telephone Number	:	318-767-8816
Fax Number	:	318-473-4279

Provider Business Practice Location Address
First Line	:	7525 HIGHWAY 71 S
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71302-9116
Country	:	US
Telephone Number	:	318-767-8816
Fax Number	:	318-473-4279

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. OCTAVIA T JACKSON
Credential	:
Telephone Number	:	318-767-8816

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	04/27/2010

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