MEDICARE: CLOVER DURABLE MEDICAL EQUIPMENT, 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	:	1336242635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER DURABLE MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	6305 ELYSIAN FIELD AVE
Second Line	:	# 206
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4245
Country	:	US
Telephone Number	:	504-283-5900
Fax Number	:	504-283-5229

Provider Business Practice Location Address
First Line	:	6305 ELYSIAN FIELD AVENUE
Second Line	:	# 206
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4245
Country	:	US
Telephone Number	:	504-283-5900
Fax Number	:	504-283-5229

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ERIN DANIELLE HAMILTON
Credential	:
Telephone Number	:	504-283-5900

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	12/04/2007

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