Organization
FUNCTIONAL DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN RYAN (OWNER)
(225) 412-9955
Entity
Organization
Contact information
Practice address
930B PRAYER HOUSE RD, WASHINGTON, LA 70589-9113
(225) 412-9955
(225) 412-9957
Mailing address
PO BOX 1772, OPELOUSAS, LA 70571-1772
(225) 412-9955
(225) 412-9957
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2494589
—
LA
Enumeration date
05/23/2018
Last updated
02/03/2021
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