Provider Demographics
NPI:1689875262
Name:QBC HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:QBC HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:DOMONICK
Authorized Official - Last Name:OLIPHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-896-2314
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-0190
Mailing Address - Country:US
Mailing Address - Phone:337-896-2314
Mailing Address - Fax:337-896-2319
Practice Address - Street 1:3551 NORTHWEST EVANGELINE THRWY
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-896-2314
Practice Address - Fax:337-896-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622508Medicaid