Provider Demographics
NPI:1891878377
Name:DELTA RURAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:DELTA RURAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-728-7177
Mailing Address - Street 1:1028 HARRISON STREET
Mailing Address - Street 2:1028 HARRISON STREET
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269
Mailing Address - Country:US
Mailing Address - Phone:318-728-7177
Mailing Address - Fax:318-728-7186
Practice Address - Street 1:1028 HARRISON STREET
Practice Address - Street 2:1028 HARRISON STREET
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269
Practice Address - Country:US
Practice Address - Phone:318-728-7177
Practice Address - Fax:318-728-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07531271Medicaid
LA1994669Medicaid
MS07531271Medicaid