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

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	:	1700020781
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	:	OWNER-CEO
Name	:	MRS. ANTWANETTE COLLINS
Credential	:
Telephone Number	:	225-454-6852

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	03/31/2010

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