Provider Demographics
NPI:1174565733
Name:ALLEN PARISH MEDICAL SUPPLY
Entity type:Organization
Organization Name:ALLEN PARISH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-305-0903
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-1560
Mailing Address - Country:US
Mailing Address - Phone:337-738-3493
Mailing Address - Fax:337-738-3494
Practice Address - Street 1:442 NORTH 9TH STREET
Practice Address - Street 2:RM 1
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3317
Practice Address - Country:US
Practice Address - Phone:337-738-3493
Practice Address - Fax:337-738-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712451Medicaid
LA1712451Medicaid