Provider Demographics
NPI:1114105939
Name:HEALTH MART OF ABBEVILLE INC.
Entity Type:Organization
Organization Name:HEALTH MART OF ABBEVILLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-523-1851
Mailing Address - Street 1:1100 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-3128
Mailing Address - Country:US
Mailing Address - Phone:337-893-5335
Mailing Address - Fax:337-893-5334
Practice Address - Street 1:1100 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-3128
Practice Address - Country:US
Practice Address - Phone:337-893-5335
Practice Address - Fax:337-893-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0017583332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies