Iberville Medical Supplies Store, LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

Legal business name

IBERVILLE MEDICAL SUPPLIES STORE, LLC

Practice address

58610 Belleview Dr
Plaquemine, LA 70764-3900

Phone

(225) 385-3155

Fax

(225) 687-6311

NPI assigned

Oct 21, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lee Ann Haggens

Title

Owner

Phone

(225) 385-3155

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1346576600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58610 BELLEVIEW DR",
            "city": "PLAQUEMINE",
            "state": "LA",
            "postal_code": "707643900",
            "telephone_number": "225-385-3155",
            "fax_number": "225-687-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58610 BELLEVIEW DR",
            "city": "PLAQUEMINE",
            "state": "LA",
            "postal_code": "707643900",
            "telephone_number": "225-385-3155",
            "fax_number": "225-687-6311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBERVILLE MEDICAL SUPPLIES STORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "HAGGENS",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-385-3155",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oxygen Equipment & Supplies (DME) in Plaquemine, LA
• Providers in Plaquemine, LA by specialty
• Oxygen Equipment & Supplies (DME) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.