Provider Demographics
NPI:1629233002
Name:SELF CATH SOLUTIONS
Entity Type:Organization
Organization Name:SELF CATH SOLUTIONS
Other - Org Name:SELF CATH SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:RICE
Authorized Official - Last Name:HALLIBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:225-266-6346
Mailing Address - Street 1:18319 MAGNOLIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3344
Mailing Address - Country:US
Mailing Address - Phone:225-266-6346
Mailing Address - Fax:225-677-5566
Practice Address - Street 1:18319 MAGNOLIA OAKS DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3344
Practice Address - Country:US
Practice Address - Phone:225-266-6346
Practice Address - Fax:225-677-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies