Provider Demographics
NPI:1134313596
Name:IV SERVICES LLC
Entity Type:Organization
Organization Name:IV SERVICES LLC
Other - Org Name:IV SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENINATE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-394-9037
Mailing Address - Street 1:1581 CAROL SUE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5100
Mailing Address - Country:US
Mailing Address - Phone:504-394-9037
Mailing Address - Fax:504-392-0973
Practice Address - Street 1:1581 CAROL SUE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5100
Practice Address - Country:US
Practice Address - Phone:504-392-0973
Practice Address - Fax:504-392-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3256IR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2201123Medicaid
LA2201123Medicaid