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Organization

MOBILITY PRODUCTS DEPOT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES WAYNE LANDRY (OWNER)
(337) 504-2743
Entity
Organization

Contact information

Practice address
510 LAFAYETTE STREET, YOUNGSVILLE, LA 70592
(337) 504-2743
(337) 504-3014
Mailing address
PO BOX 840, YOUNGSVILLE, LA 70592-0840
(337) 504-2743
(337) 504-3014

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4563805001
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1190381
LA
01
G5891
BLUE CROSS BLUE SHIELD
LA
Enumeration date
09/23/2008
Last updated
09/23/2008
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