Organization
MOBILITY PRODUCTS DEPOT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WAYNE LANDRY (OWNER)
(337) 504-2743
Entity
Organization
Contact information
Practice address
510 LAFAYETTE STREET, YOUNGSVILLE, LA 70592
(337) 504-2743
(337) 504-3014
Mailing address
PO BOX 840, YOUNGSVILLE, LA 70592-0840
(337) 504-2743
(337) 504-3014
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4563805001
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1187836
—
LA
01
—
G5891
BLUE CROSS BLUE SHIELD
LA
Enumeration date
09/23/2008
Last updated
09/23/2008
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