Provider Demographics
NPI:1235189929
Name:D & M HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:D & M HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-447-9597
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0785
Mailing Address - Country:US
Mailing Address - Phone:985-447-9597
Mailing Address - Fax:985-447-9588
Practice Address - Street 1:1713 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5224
Practice Address - Country:US
Practice Address - Phone:985-447-9597
Practice Address - Fax:985-447-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353493Medicaid
LA5667330001Medicare ID - Type UnspecifiedPROVIDER NUMBER