Provider Demographics
NPI:1013198951
Name:BRADLEY MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:BRADLEY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DAIGREPONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-253-4952
Mailing Address - Street 1:159 GUILBEAU RD
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4408
Mailing Address - Country:US
Mailing Address - Phone:318-253-4952
Mailing Address - Fax:318-253-4952
Practice Address - Street 1:159 GUILBEAU RD
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4408
Practice Address - Country:US
Practice Address - Phone:318-253-4952
Practice Address - Fax:318-253-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies