Provider Demographics
NPI:1235361932
Name:LGS MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:LGS MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:985-707-4013
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-0992
Mailing Address - Country:US
Mailing Address - Phone:985-639-3341
Mailing Address - Fax:985-639-3334
Practice Address - Street 1:1040 OLD SPANISH TRL
Practice Address - Street 2:SUITE 6
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5008
Practice Address - Country:US
Practice Address - Phone:985-639-3341
Practice Address - Fax:985-639-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6319310001Medicare NSC