Provider Demographics
NPI:1396813424
Name:MEDICAL SUPPLIES OF BATON ROUGE
Entity Type:Organization
Organization Name:MEDICAL SUPPLIES OF BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMPSON
Authorized Official - Middle Name:WEBILOR
Authorized Official - Last Name:CHINWOH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:225-354-1082
Mailing Address - Street 1:4326 NORTH FOSTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805
Mailing Address - Country:US
Mailing Address - Phone:225-354-1082
Mailing Address - Fax:225-354-1090
Practice Address - Street 1:4326 NORTH FOSTER DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805
Practice Address - Country:US
Practice Address - Phone:225-354-1082
Practice Address - Fax:225-354-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476480Medicaid
LA1476480Medicaid