Provider Demographics
NPI:1235382698
Name:VERNON MEDICAL CARE LLC
Entity Type:Organization
Organization Name:VERNON MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-392-1871
Mailing Address - Street 1:111 W HARRIET ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4445
Mailing Address - Country:US
Mailing Address - Phone:337-238-5409
Mailing Address - Fax:337-238-5411
Practice Address - Street 1:111 W HARRIET ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4445
Practice Address - Country:US
Practice Address - Phone:337-238-5409
Practice Address - Fax:337-238-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6326150001Medicare NSC