Provider Demographics
NPI:1144229162
Name:ASHLEY MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity Type:Organization
Organization Name:ASHLEY MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:MLT ASCP
Authorized Official - Phone:318-676-0881
Mailing Address - Street 1:1435 HAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6533
Mailing Address - Country:US
Mailing Address - Phone:318-676-0881
Mailing Address - Fax:318-676-0885
Practice Address - Street 1:1435 HAWN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6533
Practice Address - Country:US
Practice Address - Phone:318-676-0881
Practice Address - Fax:318-676-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHLEY MEDICAL EQUIPMENT & SUPPLIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA090010826332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152623716Medicaid
TX163425501Medicaid
LA1167983Medicaid
AK152623716Medicaid
LA4864830001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT