MEDICARE: MOBILITY PRODUCTS DEPOT 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
2	G5891	OTHER	LA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952308207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY PRODUCTS DEPOT LLC

Provider Business Mailing Address
First Line	:	PO BOX 840
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-0840
Country	:	US
Telephone Number	:	337-504-2743
Fax Number	:	337-504-3014

Provider Business Practice Location Address
First Line	:	510 LAFAYETTE STREET
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592
Country	:	US
Telephone Number	:	337-504-2743
Fax Number	:	337-504-3014

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES W. LANDRY
Credential	:
Telephone Number	:	337-504-2743

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/28/2008

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Directions to “MOBILITY PRODUCTS DEPOT LLC ” Practice Location

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