Provider Demographics
NPI:1073627568
Name:MARIE'S MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:MARIE'S MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-338-3550
Mailing Address - Street 1:PO BOX 2174
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2174
Mailing Address - Country:US
Mailing Address - Phone:318-338-3550
Mailing Address - Fax:318-338-3551
Practice Address - Street 1:775 S BONNER ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5801
Practice Address - Country:US
Practice Address - Phone:318-255-3077
Practice Address - Fax:318-255-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA370011363332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433209Medicaid
1322210002Medicare ID - Type Unspecified