Provider Demographics
NPI:1952499972
Name:DOUROUX PROSTHETIC-ORTHOTIC SERVICES, LLC
Entity type:Organization
Organization Name:DOUROUX PROSTHETIC-ORTHOTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER,CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:DOUROUX
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PROSTHETIS
Authorized Official - Phone:504-368-1477
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-0661
Mailing Address - Country:US
Mailing Address - Phone:504-915-1234
Mailing Address - Fax:985-307-0054
Practice Address - Street 1:448 TERRY PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-2792
Practice Address - Country:US
Practice Address - Phone:504-368-1477
Practice Address - Fax:504-368-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559661Medicaid
LA1559661Medicaid