Provider Demographics
NPI:1679604557
Name:OMEGA MEDICAL SUPPLY CO. LLC
Entity Type:Organization
Organization Name:OMEGA MEDICAL SUPPLY CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-667-9669
Mailing Address - Street 1:1970 FLORIDA AVE SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4948
Mailing Address - Country:US
Mailing Address - Phone:225-667-9669
Mailing Address - Fax:225-667-9636
Practice Address - Street 1:1970 FLORIDA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4948
Practice Address - Country:US
Practice Address - Phone:225-667-9669
Practice Address - Fax:225-667-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679604557OtherNPI
LA1029963Medicaid
LA1679604557OtherNPI