Provider Demographics
NPI:1932253903
Name:FIRST RESPONSE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:FIRST RESPONSE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-746-7774
Mailing Address - Street 1:1701 OLD MINDEN RD
Mailing Address - Street 2:SUITE 33
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4800
Mailing Address - Country:US
Mailing Address - Phone:318-746-7774
Mailing Address - Fax:318-746-7211
Practice Address - Street 1:1701 OLD MINDEN RD
Practice Address - Street 2:SUITE 33
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4800
Practice Address - Country:US
Practice Address - Phone:318-746-7774
Practice Address - Fax:318-746-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1629006Medicaid
LA5450880001Medicare NSC