Organization
PCG MEDICAL,LLC
Active
Parent organization
PCG MEDICAL REVOCABLE TRUST DATE AUGUST 3, 2005
Organization subpart
Yes
Provider details
NPI number
Legal business name
PCG MEDICAL REVOCABLE TRUST DATE AUGUST 3, 2005
Authorized official
MICHELINE STEPHENS OWNER (OWNER)
(504) 836-3899
Entity
Organization
Contact information
Practice address
3350 RIDGELAKE DR STE 280, METAIRIE, LA 70002-3873
(504) 836-3899
(504) 836-3899
Mailing address
3350 RIDGELAKE DR, SUITE NUMBER 200, METAIRIE, LA 70002-3831
(504) 836-3899
(504) 836-3899
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1529273
—
LA
Enumeration date
05/19/2006
Last updated
09/16/2021
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