Organization
NORTHLAKE MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY NICHOLAS TEBBS (OWNER)
(253) 377-1358
Entity
Organization
Contact information
Practice address
70360 HIGHWAY 21 STE 2, COVINGTON, LA 70433-8145
(985) 892-7709
(985) 892-7322
Mailing address
PO BOX 2737, COVINGTON, LA 70434-2737
(985) 892-7709
(985) 892-7322
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1343692
—
LA
Enumeration date
06/02/2006
Last updated
07/13/2021
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