Provider Demographics
NPI:1215267059
Name:D AND T MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:D AND T MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-542-3694
Mailing Address - Street 1:3658 GOVERNMENT ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-3324
Mailing Address - Country:US
Mailing Address - Phone:318-445-4250
Mailing Address - Fax:318-487-9194
Practice Address - Street 1:3658 GOVERNMENT ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3324
Practice Address - Country:US
Practice Address - Phone:318-445-4250
Practice Address - Fax:318-487-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6358760001Medicare NSC