Provider Demographics
NPI:1053322594
Name:FAME MAKER PRODUCTIONS, LLC
Entity Type:Organization
Organization Name:FAME MAKER PRODUCTIONS, LLC
Other - Org Name:MAGNOLIA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:DARNELLE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-744-4455
Mailing Address - Street 1:38099 POST OFFICE RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4290
Mailing Address - Country:US
Mailing Address - Phone:225-744-4455
Mailing Address - Fax:225-744-4499
Practice Address - Street 1:38099 POST OFFICE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4290
Practice Address - Country:US
Practice Address - Phone:225-744-4455
Practice Address - Fax:225-744-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies