Provider Demographics
NPI:1245388610
Name:EVANGELINE MEDICAL & NURSING SUPPLY, INC
Entity type:Organization
Organization Name:EVANGELINE MEDICAL & NURSING SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCELWEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN CO OWNER
Authorized Official - Phone:337-363-3638
Mailing Address - Street 1:107 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-3034
Mailing Address - Country:US
Mailing Address - Phone:318-335-0520
Mailing Address - Fax:318-335-0508
Practice Address - Street 1:107 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-335-0520
Practice Address - Fax:318-335-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2700326001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477753Medicaid
LA1477753Medicaid