Provider Demographics
NPI:1982646501
Name:PETERS,LLC
Entity Type:Organization
Organization Name:PETERS,LLC
Other - Org Name:PETERS, LLC - DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE/CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVEDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-986-4400
Mailing Address - Street 1:29257 COTNEY PETERS RD
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-1868
Mailing Address - Country:US
Mailing Address - Phone:985-986-4400
Mailing Address - Fax:985-986-4411
Practice Address - Street 1:29257 COTNEY PETERS RD
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-1868
Practice Address - Country:US
Practice Address - Phone:985-986-4400
Practice Address - Fax:985-986-4411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETERS,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1030287Medicaid
LAC08502849OtherEDI SUBMITTER
LA1030287Medicaid