Provider Demographics
NPI:1891822466
Name:T L EQUIPMENT DISTRIBUTORS, INC.
Entity Type:Organization
Organization Name:T L EQUIPMENT DISTRIBUTORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-7252
Mailing Address - Street 1:5213 BUTTER CREEK LN
Mailing Address - Street 2:STE. #2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3651
Mailing Address - Country:US
Mailing Address - Phone:225-769-7252
Mailing Address - Fax:877-528-2079
Practice Address - Street 1:5213 BUTTER CREEK LN
Practice Address - Street 2:STE. #2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3651
Practice Address - Country:US
Practice Address - Phone:225-769-7252
Practice Address - Fax:877-528-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158453Medicaid
LA1158453Medicaid