Provider Demographics
NPI:1235256116
Name:PATIENTS CARE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:PATIENTS CARE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DARTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-989-0005
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-0246
Mailing Address - Country:US
Mailing Address - Phone:337-989-0005
Mailing Address - Fax:337-989-0006
Practice Address - Street 1:8907 MAURICE AVE.
Practice Address - Street 2:
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-4439
Practice Address - Country:US
Practice Address - Phone:337-989-0005
Practice Address - Fax:337-989-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA570011607332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH3210OtherBLUE CROSS BLUE SHIELD
LA1325104Medicaid
LAH3210OtherBLUE CROSS BLUE SHIELD