Provider Demographics
NPI:1033140132
Name:UROSOURCE LLC
Entity Type:Organization
Organization Name:UROSOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:KERNER
Authorized Official - Last Name:FALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-739-2239
Mailing Address - Street 1:127 S. SOUTHLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3337
Mailing Address - Country:US
Mailing Address - Phone:337-739-2239
Mailing Address - Fax:337-266-9598
Practice Address - Street 1:401 AUDUBON BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-739-2239
Practice Address - Fax:337-266-9598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1706159Medicaid