Provider Demographics
NPI:1700180205
Name:DURIABLE MEDICAL EQUIPMENT OF KEITHVILLE
Entity Type:Organization
Organization Name:DURIABLE MEDICAL EQUIPMENT OF KEITHVILLE
Other - Org Name:K CENTER OF KEITHVILLE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OFFICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-775-5362
Mailing Address - Street 1:11038 DOMINO DR
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-8308
Mailing Address - Country:US
Mailing Address - Phone:318-775-5362
Mailing Address - Fax:318-775-5362
Practice Address - Street 1:11038 DOMINO DR
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-8308
Practice Address - Country:US
Practice Address - Phone:318-775-5362
Practice Address - Fax:318-775-5362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K CENTER OF KEITHVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies