MEDICARE: ALL-CARE MEDICAL SUPPLY, LLC

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

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	:	1104021922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL-CARE MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	4120 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-442-2200
Fax Number	:	318-442-2208

Provider Business Practice Location Address
First Line	:	4120 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-442-2200
Fax Number	:	318-442-2208

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	MR. DAVID J. BOISVERT
Credential	:
Telephone Number	:	203-520-8544

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	01/04/2008

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