Provider Demographics
NPI:1295704039
Name:B&D MEDICAL ,INC.
Entity type:Organization
Organization Name:B&D MEDICAL ,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENECKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-746-2395
Mailing Address - Street 1:1613 JIMMIE DAVIS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4557
Mailing Address - Country:US
Mailing Address - Phone:318-746-2395
Mailing Address - Fax:318-746-2394
Practice Address - Street 1:1613 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4557
Practice Address - Country:US
Practice Address - Phone:318-746-2395
Practice Address - Fax:318-746-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07788332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1566233Medicaid
LA1566233Medicaid