Provider Demographics
NPI:1215995592
Name:TALBERTS MEDICAL LLC
Entity type:Organization
Organization Name:TALBERTS MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-2119
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:SUITE 521
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-0580
Mailing Address - Country:US
Mailing Address - Phone:337-439-2119
Mailing Address - Fax:337-439-2120
Practice Address - Street 1:1011 LAKE SHORE DR
Practice Address - Street 2:SUITE 521
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-9412
Practice Address - Country:US
Practice Address - Phone:337-439-2119
Practice Address - Fax:337-439-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332BD1200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4502079Medicaid
LAL0729OtherMEDICARE SUBMITTER