Provider Demographics
NPI:1760051700
Name:LOCOST MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:LOCOST MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-654-5305
Mailing Address - Street 1:2780 PEACHTREE INDUSTRIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8033
Mailing Address - Country:US
Mailing Address - Phone:678-584-2223
Mailing Address - Fax:
Practice Address - Street 1:2780 PEACHTREE INDUSTRIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8033
Practice Address - Country:US
Practice Address - Phone:678-584-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies