Organization
DURAMED, INC
Active
Parent organization
DURAMED, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DURAMED, INC
Authorized official
MR. RICKY WALTER DECASTRO SR. (PRESIDENT)
(504) 467-4057
Entity
Organization
Contact information
Practice address
11135 INDUSTRIPLEX BLVD, SUITE 800, BATON ROUGE, LA 70809-4114
(225) 751-1224
(225) 751-1224
Mailing address
1015 24TH ST, KENNER, LA 70062-5268
(504) 467-4057
(504) 467-4053
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669814
—
LA
01
—
B6939
BCBS OF LOUISIANA
LA
Enumeration date
01/15/2013
Last updated
01/18/2013
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