Provider Demographics
NPI:1306340328
Name:MEDI-SCRIPT INC
Entity type:Organization
Organization Name:MEDI-SCRIPT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SURMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-326-4759
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064-0216
Mailing Address - Country:US
Mailing Address - Phone:318-326-4759
Mailing Address - Fax:318-326-7383
Practice Address - Street 1:200 E PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-4258
Practice Address - Country:US
Practice Address - Phone:318-326-4759
Practice Address - Fax:318-326-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007540-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1242705Medicaid