Provider Demographics
NPI:1164577276
Name:EMERALD MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EMERALD MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-772-3071
Mailing Address - Street 1:39362 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4836
Mailing Address - Country:US
Mailing Address - Phone:225-772-3071
Mailing Address - Fax:225-622-6083
Practice Address - Street 1:39362 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4836
Practice Address - Country:US
Practice Address - Phone:225-772-3071
Practice Address - Fax:225-622-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies