MEDICARE: MELANCON MEDICAL EQUIPMENT AND SUPPLIES

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	:	1366881153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANCON MEDICAL EQUIPMENT AND SUPPLIES

Provider Business Mailing Address
First Line	:	709 S LEWIS ST STE E
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4858
Country	:	US
Telephone Number	:	337-376-6383
Fax Number	:	337-376-6385

Provider Business Practice Location Address
First Line	:	709 S LEWIS ST STE E
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4858
Country	:	US
Telephone Number	:	337-376-6383
Fax Number	:	337-376-6385

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	CAROL JUDE MELANCON
Credential	:
Telephone Number	:	337-376-6383

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	03/17/2014

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