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Organization
MERIDIAN MEDICAL SUPPLY LLC
Active
Organization
MERIDIAN MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIE JACK CORLEY SR. M.D. (OPERATIONS MANAGER)
(318) 256-5700
Entity
Organization
Contact information
Practice address
1029 KEYSER AVE, SUITE M2, NATCHITOCHES, LA 71457-6239
(318) 238-7350
(318) 238-7351
Mailing address
1029 KEYSER AVE, SUITE M2, NATCHITOCHES, LA 71457-6239
(318) 238-7350
(318) 238-7351
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
35-0012400
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356182
—
LA
Enumeration date
11/02/2010
Last updated
11/02/2010
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