MEDICARE: P P S I OF VILLE PLATTE 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	2536-IR	LA
2	3336C0003X	Community/Retail Pharmacy	2536-IR	LA
3	3336H0001X	Home Infusion Therapy Pharmacy	2536-IR	LA
4	332B00000X	Durable Medical Equipment & Medical Supplies	2536-IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1925203	OTHER	LA	NABP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	53031	OTHER	LA	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1457320343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P P S I OF VILLE PLATTE INC

Provider Business Mailing Address
First Line	:	409A E LINCOLN RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-2183
Fax Number	:	337-363-2187

Provider Business Practice Location Address
First Line	:	409A E LINCOLN RD
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586-3431
Country	:	US
Telephone Number	:	337-363-2183
Fax Number	:	337-363-2187

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES G SOILEAU
Credential	:
Telephone Number	:	337-363-2183

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/20/2011

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Practice Location Address:

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70586-3431

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1720125511 — DR. STEVEN B VIDRINE MD
Practice Location Address:

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VILLE PLATTE, LA
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1427199207 — DR. THOMAS GLENN FONTENOT M.D,
Practice Location Address:

417 E. LINCOLN RD
VILLE PLATTE, LA
70586-3431

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Practice Fax: 337-363-5166

1154671733 — THOMAS G. FONTENOT, MD
Practice Location Address:

417 EAST LINCOLN ROAD
VILLE PLATTE, LA
70586-3431

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Practice Fax:

1689918328 — DR. THOMAS FONTENOT
Practice Location Address:

417 E LINCOLN RD , SUITE A
VILLE PLATTE, LA
70586-3431

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1346778123 — MR. JACE AARON HOLMES FNP
Practice Location Address:

417 E LINCOLN RD
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70586-3431

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Directions to “P P S I OF VILLE PLATTE INC ” Practice Location

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