Provider Demographics
NPI:1073816435
Name:RESURGENTMD, INC.
Entity Type:Organization
Organization Name:RESURGENTMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-841-4312
Mailing Address - Street 1:PO BOX 6657
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6657
Mailing Address - Country:US
Mailing Address - Phone:318-869-4555
Mailing Address - Fax:318-841-4350
Practice Address - Street 1:242 LYNBROOK BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6548
Practice Address - Country:US
Practice Address - Phone:318-869-4555
Practice Address - Fax:318-841-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment