Organization
MEDCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY TALLEY (MEMBER)
(225) 647-3500
Entity
Organization
Contact information
Practice address
908 WEST ORICE ROTH ROAD, GONZALES, LA 70737-3006
(225) 647-3500
(225) 644-1234
Mailing address
908 WEST ORICE ROTH ROAD, GONZALES, LA 70737-3006
(225) 647-3500
(225) 644-1234
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1672939
—
LA
01
—
1779001
MEDICAID
TX
01
—
286286
WELLCARE
LA
01
—
300408731
BLUE CROSS BLUE SHIELD
LA
Enumeration date
12/26/2007
Last updated
07/21/2022
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