Provider Demographics
NPI:1972554103
Name:MERIDIAN MEDICAL SUPPLY L.L.C.
Entity Type:Organization
Organization Name:MERIDIAN MEDICAL SUPPLY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-590-2273
Mailing Address - Street 1:1005 FISHER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3833
Mailing Address - Country:US
Mailing Address - Phone:318-590-2273
Mailing Address - Fax:318-256-5950
Practice Address - Street 1:1005 FISHER RD
Practice Address - Street 2:SUITE D
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3833
Practice Address - Country:US
Practice Address - Phone:318-590-2273
Practice Address - Fax:318-256-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1356182Medicaid
LA5534120001Medicare ID - Type Unspecified