Provider Demographics
NPI:1790892156
Name:DESIREE QUIRK D/B/A LAGNIAPPE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DESIREE QUIRK D/B/A LAGNIAPPE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-845-1448
Mailing Address - Street 1:303 COVINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9685
Mailing Address - Country:US
Mailing Address - Phone:985-845-1448
Mailing Address - Fax:985-845-1449
Practice Address - Street 1:303 COVINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9685
Practice Address - Country:US
Practice Address - Phone:985-845-1448
Practice Address - Fax:985-845-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08068332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5751070001Medicare NSC