Provider Demographics
NPI:1639136765
Name:HARD PARTS & SUPPLIES INC
Entity Type:Organization
Organization Name:HARD PARTS & SUPPLIES INC
Other - Org Name:BENTON MEDICAL & NURSING SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-965-9270
Mailing Address - Street 1:854 LINTON RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-9700
Mailing Address - Country:US
Mailing Address - Phone:318-965-3899
Mailing Address - Fax:318-965-9270
Practice Address - Street 1:854 LINTON RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-9700
Practice Address - Country:US
Practice Address - Phone:318-965-3899
Practice Address - Fax:318-965-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529125Medicaid
LA5104880001Medicare NSC