Provider Demographics
NPI:1679039440
Name:CHAMPION MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:CHAMPION MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DEBELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-244-9087
Mailing Address - Street 1:408 FOS AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2827
Mailing Address - Country:US
Mailing Address - Phone:508-244-9087
Mailing Address - Fax:
Practice Address - Street 1:408 FOS AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2827
Practice Address - Country:US
Practice Address - Phone:508-244-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies