MEDICARE: J & R LAGRANGE, 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	100818	KY
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	100818	KY
3	335E00000X	Prosthetic/Orthotic Supplier	100818	KY
4	332BN1400X	Nursing Facility Supplies (DME)
5	225X00000X	Occupational Therapist
6	235Z00000X	Speech-Language Pathologist
7	225100000X	Physical Therapist
8	314000000X	Skilled Nursing Facility	100818	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000054853	OTHER	KY	ANTHEM BC/BS
2	2702411000	OTHER	KY	PASSPORT ADVANTAGE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700978806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & R LAGRANGE, LLC

Provider Business Mailing Address
First Line	:	1012 RICHWOOD WAY
Second Line	:
City	:	LAGRANGE
State	:	KY
Zip	:	40031-8930
Country	:	US
Telephone Number	:	502-222-3186
Fax Number	:	502-222-6535

Provider Business Practice Location Address
First Line	:	1012 RICHWOOD WAY
Second Line	:
City	:	LAGRANGE
State	:	KY
Zip	:	40031-8930
Country	:	US
Telephone Number	:	502-222-3186
Fax Number	:	502-222-6535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK BOWMAN
Credential	:
Telephone Number	:	859-272-6682

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/24/2008

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Directions to “J & R LAGRANGE, LLC ” Practice Location

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