Organization
TAP-ALERT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JANNERO TEMPLE (OWNER / MANAGER)
(844) 827-2537
Entity
Organization
Contact information
Practice address
3305 W 70TH ST UNIT D, SHREVEPORT, LA 71108-4609
(844) 827-2537
Mailing address
3305 W 70TH ST UNIT D, SHREVEPORT, LA 71108-4609
(844) 827-2537
Taxonomy
Speciality
Code
Description
License number
State
332100000X
Department of Veterans Affairs (VA) Pharmacy
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333300000X
Emergency Response System Companies
Primary
—
—
Other
Enumeration date
05/23/2014
Last updated
03/04/2015
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