Provider Demographics
NPI:1356413025
Name:MCO OF LOUISIANA INC
Entity type:Organization
Organization Name:MCO OF LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-628-6900
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:430 WEST SOUTH STREET
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483
Mailing Address - Country:US
Mailing Address - Phone:318-628-6900
Mailing Address - Fax:318-628-6111
Practice Address - Street 1:430 WEST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483
Practice Address - Country:US
Practice Address - Phone:318-628-6900
Practice Address - Fax:318-628-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1930351Medicaid
LA1930351Medicaid