MEDICARE: RED BALL MEDICAL SUPPLY, INC

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	09-0007047	LA
2	332BX2000X	Oxygen Equipment & Supplies (DME)	4028	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
2	27623	OTHER	LA	BLUE CROSS
3	56735	OTHER	LA	NORTHWOOD

General Provider Information

NPI Number	:	1174509350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED BALL MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	PO BOX 7623
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71137-7623
Country	:	US
Telephone Number	:	318-424-8393
Fax Number	:	318-222-6104

Provider Business Practice Location Address
First Line	:	1020 N MARKET ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-6747
Country	:	US
Telephone Number	:	318-424-8393
Fax Number	:	318-222-6104

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	JUDITH K STORER
Credential	:
Telephone Number	:	318-424-8393

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	03/16/2011

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Directions to “RED BALL MEDICAL SUPPLY, INC ” Practice Location

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