MEDICARE: PDI OF THE SOUTH, 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	251E00000X	Home Health Agency	2203781957	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	:	1356735005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PDI OF THE SOUTH, INC.

Provider Business Mailing Address
First Line	:	727 RYAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-4242
Country	:	US
Telephone Number	:	337-479-0048
Fax Number	:	337-479-0685

Provider Business Practice Location Address
First Line	:	727 RYAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-4242
Country	:	US
Telephone Number	:	337-479-0048
Fax Number	:	337-479-0685

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARGARET DESTOUT
Credential	:
Telephone Number	:	337-479-0048

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	03/20/2015

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