Provider Demographics
NPI:1093931966
Name:PR NURSING SUPPLY LLC
Entity Type:Organization
Organization Name:PR NURSING SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-9614
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71309-0191
Mailing Address - Country:US
Mailing Address - Phone:318-443-9614
Mailing Address - Fax:318-487-1957
Practice Address - Street 1:534 MURRAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8019
Practice Address - Country:US
Practice Address - Phone:318-443-9614
Practice Address - Fax:318-487-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1461521Medicaid
LA4978510001Medicare NSC