MEDICARE: EZ-MEDICAL SUPPLIES & SERVICES 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	332B00000X	Durable Medical Equipment & Medical Supplies		LA

General Provider Information

NPI Number	:	1811189905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ-MEDICAL SUPPLIES & SERVICES INC.

Provider Business Mailing Address
First Line	:	1724 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1402
Country	:	US
Telephone Number	:	225-248-1401
Fax Number	:	225-248-1404

Provider Business Practice Location Address
First Line	:	1724 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1402
Country	:	US
Telephone Number	:	224-248-1401
Fax Number	:	225-248-1404

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. MONDAY NNA EZEBUNWO
Credential	:
Telephone Number	:	225-248-1401

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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