Provider Demographics
NPI:1164611562
Name:DRIGGERS DIABETIC SUPPLY LLC
Entity Type:Organization
Organization Name:DRIGGERS DIABETIC SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICCI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-349-2816
Mailing Address - Street 1:9087 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2533
Mailing Address - Country:US
Mailing Address - Phone:318-364-8301
Mailing Address - Fax:
Practice Address - Street 1:9300 MANSFIELD RD
Practice Address - Street 2:# 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2533
Practice Address - Country:US
Practice Address - Phone:318-349-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies