Provider Demographics
NPI:1710923255
Name:DURAMED, INC.
Entity Type:Organization
Organization Name:DURAMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-467-4057
Mailing Address - Street 1:1015 24TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5268
Mailing Address - Country:US
Mailing Address - Phone:504-467-4057
Mailing Address - Fax:504-467-4053
Practice Address - Street 1:1015 24TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5268
Practice Address - Country:US
Practice Address - Phone:504-467-4057
Practice Address - Fax:504-467-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669814Medicaid
LAB6939OtherBCBS PROVIDER #
LA0959380001Medicare NSC