Provider Demographics
NPI:1518409663
Name:CRESCENT DURABLE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:CRESCENT DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:GENGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-277-2995
Mailing Address - Street 1:8301 W JUDGE PEREZ DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1657
Mailing Address - Country:US
Mailing Address - Phone:504-277-2995
Mailing Address - Fax:504-279-1474
Practice Address - Street 1:8301 W JUDGE PEREZ DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1657
Practice Address - Country:US
Practice Address - Phone:504-277-2995
Practice Address - Fax:504-279-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies