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Organization
DERIDDER MEDICAL EQUIPMENT SUPPLY
Active
Organization
DERIDDER MEDICAL EQUIPMENT SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENTON RUDOLPH BLAKENEY (OWNER)
(337) 463-5291
Entity
Organization
Contact information
Practice address
709 MAHLON ST, DERIDDER, LA 70634-4221
(337) 202-1911
(337) 202-1913
Mailing address
2661 RUSS ST, DERIDDER, LA 70634-6035
(337) 463-5291
(337) 463-5368
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
05/02/2011
Last updated
05/03/2011
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