Provider Demographics
NPI:1396810990
Name:TERRY'S MEDICAL SPECIALTIES LLC
Entity type:Organization
Organization Name:TERRY'S MEDICAL SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:337-981-0744
Mailing Address - Street 1:119 LEONIE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6227
Mailing Address - Country:US
Mailing Address - Phone:337-981-0744
Mailing Address - Fax:337-981-9955
Practice Address - Street 1:119 LEONIE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6227
Practice Address - Country:US
Practice Address - Phone:337-981-0744
Practice Address - Fax:337-981-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1374156Medicaid
LA6165770001Medicare NSC