Organization
REVIVE RESPIRATORY AND DME LLC
Active
Other names
Revive Respiratory and DME LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VERA MITCHELL WARE RRT (OWNER/MANAGER)
(318) 687-8813
Entity
Organization
Contact information
Practice address
9591 WALLACE LAKE RD, SHREVEPORT, LA 71106-7535
(318) 687-8813
(318) 687-8813
Mailing address
9591 WALLACE LAKE RD, SHREVEPORT, LA 71106-7535
(318) 687-8813
(318) 687-8813
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
LT3525
LA
Other
Enumeration date
07/20/2010
Last updated
07/22/2010
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