Organization
GEAUXPRODME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THEODORE FLOYD FREE (MANAGER)
(321) 501-5565
Entity
Organization
Contact information
Practice address
1304 CHAMPAGNE STREET, COVINGTON, LA 70433
(985) 809-0444
Mailing address
1304 CHAMPAGNE STREET, COVINGTON, LA 70433
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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