Provider Demographics
NPI:1447395256
Name:LOUISIANA HOME MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:LOUISIANA HOME MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:DEVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-683-4878
Mailing Address - Street 1:POST OFFICE BOX 8189
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:70722-1189
Mailing Address - Country:US
Mailing Address - Phone:225-683-4878
Mailing Address - Fax:225-683-4869
Practice Address - Street 1:17943 HIGHWAY 432
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-4027
Practice Address - Country:US
Practice Address - Phone:225-683-4878
Practice Address - Fax:225-683-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1160636Medicaid
LA1160636Medicaid