MEDICARE: ABSOLUTE MEDICAL SUPPLY

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	:	1932396041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2028 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7468
Country	:	US
Telephone Number	:	337-493-8554
Fax Number	:	337-493-8594

Provider Business Practice Location Address
First Line	:	2028 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7468
Country	:	US
Telephone Number	:	337-493-8554
Fax Number	:	337-493-8594

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RUSTY JOHN DODD
Credential	:
Telephone Number	:	337-493-8554

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	11/09/2007

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Directions to “ABSOLUTE MEDICAL SUPPLY ” Practice Location

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