Provider Demographics
NPI:1457578320
Name:GRACE MEDICAL EQUIPMENT &SUPPLIES INC.
Entity Type:Organization
Organization Name:GRACE MEDICAL EQUIPMENT &SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-3325
Mailing Address - Street 1:2665 WINNSBORO RD LOT 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-9582
Mailing Address - Country:US
Mailing Address - Phone:318-322-3325
Mailing Address - Fax:318-322-3365
Practice Address - Street 1:2665 WINNSBORO RD LOT 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-9582
Practice Address - Country:US
Practice Address - Phone:318-322-3325
Practice Address - Fax:318-322-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471356Medicaid
LA1471356Medicaid