MEDICARE: MARIAN'S MEDICAL SUPPLIES, 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

General Provider Information

NPI Number	:	1306337787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAN'S MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 41092
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70835-1092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11447 FLORIDA BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2404
Country	:	US
Telephone Number	:	225-454-6852
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTWANETTE COLLINS
Credential	:
Telephone Number	:	225-454-6852

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	05/22/2018

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