Provider Demographics
NPI:1356380760
Name:PATIENTS CARE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:PATIENTS CARE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-989-0005
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:LA
Mailing Address - Zip Code:70555-0246
Mailing Address - Country:US
Mailing Address - Phone:337-989-0005
Mailing Address - Fax:337-989-0006
Practice Address - Street 1:8907 MAURICE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MAURICE
Practice Address - State:LA
Practice Address - Zip Code:70555-4439
Practice Address - Country:US
Practice Address - Phone:337-989-0005
Practice Address - Fax:337-989-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1325104Medicaid
LAH3210OtherBLUE CROSS BLUE SHIELD
LA5607220001Medicare NSC