Provider Demographics
NPI:1992738025
Name:CENTRAL LOUISIANA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:CENTRAL LOUISIANA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAYEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-240-7369
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-0248
Mailing Address - Country:US
Mailing Address - Phone:318-240-7369
Mailing Address - Fax:318-240-9437
Practice Address - Street 1:125 RUE DE MEDECINE
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2426
Practice Address - Country:US
Practice Address - Phone:318-240-7369
Practice Address - Fax:318-240-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187046Medicaid
LA1187046Medicaid