Provider Demographics
NPI:1447607502
Name:BAYOUSIDE DME LLC
Entity Type:Organization
Organization Name:BAYOUSIDE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELINUS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:985-713-1456
Mailing Address - Street 1:7717 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4496
Mailing Address - Country:US
Mailing Address - Phone:985-713-1456
Mailing Address - Fax:888-765-1319
Practice Address - Street 1:7717 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4496
Practice Address - Country:US
Practice Address - Phone:985-713-1456
Practice Address - Fax:888-765-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies