Organization
RUSSELL K BENEVAGE
Active
Other names
Allied Medical Equipment Repair & Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL BENEVAGE (OWNER)
(337) 533-0001
Entity
Organization
Contact information
Practice address
842 S POST OAK RD, SULPHUR, LA 70663-5244
(337) 533-0001
(337) 533-0007
Mailing address
PO BOX 1627, SULPHUR, LA 70664-1627
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1195910
—
LA
Enumeration date
01/03/2008
Last updated
01/03/2008
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