Organization
DURAMED, INC
Active
Parent organization
DURAMED, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DURAMED, INC
Authorized official
MR. RICKY WALTER DECASTRO SR. (PRESIDENT)
(504) 467-4057
Entity
Organization
Contact information
Practice address
1151 BARATARIA BLVD STE 1100, MARRERO, LA 70072-3044
(504) 467-4057
(504) 467-4053
Mailing address
1015 24TH ST, KENNER, LA 70062-5268
(504) 467-4057
(504) 467-4057
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669814
—
LA
01
—
B6939
BLUE CROSS BLUE SHIELD
LA
Enumeration date
01/17/2013
Last updated
08/23/2022
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