Organization
L.A. MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA JACKSON (OWNER)
(606) 599-9140
Entity
Organization
Contact information
Practice address
1621 S HIGHWAY 421, STE 2, MANCHESTER, KY 40962
(606) 599-9140
(606) 598-0471
Mailing address
1621 S HIGHWAY 421 STE 2, MANCHESTER, KY 40962-7514
(606) 599-9140
(606) 598-0471
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000069793
ANTHEM PROVIDER NUMBER
KY
01
—
000001181580
CHA PROVIDER NUMBER
KY
05
—
45002821
—
KY
05
—
7100202840
—
KY
Enumeration date
11/14/2006
Last updated
06/03/2020
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