Organization
GREENWAY MEDICAL INC.
Active
Other names
DIABETES SOURCE RX
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MOLLY MOUTON (VICE PRESIDENT)
(337) 267-7470
Entity
Organization
Contact information
Practice address
803 COOLIDGE BLVD, SUITE 128, LAFAYETTE, LA 70503-2376
(337) 267-7470
(866) 794-5729
Mailing address
PO BOX 52884, LAFAYETTE, LA 70505-2884
(337) 267-7470
(866) 794-5729
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010164401
—
TX
05
—
011633701
—
TX
05
—
1467537
—
LA
01
—
519779
BCBS OF TEXAS
TX
01
—
G9723
BCBS OF LOUISIANA
LA
Enumeration date
10/20/2005
Last updated
04/23/2009
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