Provider Demographics
NPI:1578800157
Name:DURAMED, INC
Entity Type:Organization
Organization Name:DURAMED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-467-4057
Mailing Address - Street 1:1015 24TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5268
Mailing Address - Country:US
Mailing Address - Phone:504-467-4057
Mailing Address - Fax:504-467-4053
Practice Address - Street 1:11135 INDUSTRIPLEX BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4114
Practice Address - Country:US
Practice Address - Phone:225-751-1224
Practice Address - Fax:225-751-1224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURAMED, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669814Medicaid
LAB6939OtherBCBS OF LOUISIANA
LA0959380001Medicare NSC