Organization
PRIME SOURCE MEDICAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JADE U IRONDI (PRESIDENT)
(318) 687-6776
Entity
Organization
Contact information
Practice address
2715 MACKEY PL STE 116, SHREVEPORT, LA 71118-2528
(318) 687-6776
(318) 687-6996
Mailing address
2715 MACKEY PL STE 116, SHREVEPORT, LA 71118-2528
(318) 687-6776
(318) 687-6996
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00213555
LA
332B00000X
Durable Medical Equipment & Medical Supplies
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Other
Enumeration date
04/21/2008
Last updated
04/21/2008
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