Organization
MERIDIAN MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIE JACK CORLEY SR. M.D. (OPERATIONS MANAGER)
(318) 256-5700
Entity
Organization
Contact information
Practice address
1029 KEYSER AVE, SUITE M2, NATCHITOCHES, LA 71457-6239
(318) 238-7350
(318) 238-7351
Mailing address
1029 KEYSER AVE, SUITE M2, NATCHITOCHES, LA 71457-6239
(318) 238-7350
(318) 238-7351
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
35-0012400
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356182
—
LA
Enumeration date
11/02/2010
Last updated
11/02/2010
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