Functional DME

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

FUNCTIONAL DME

Practice address

930B Prayer House Rd
Washington, LA 70589-9113

Phone

(225) 412-9955

Fax

(225) 412-9957

NPI assigned

May 23, 2018

Last updated

Feb 3, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Colleen Ryan

Title

Owner

Phone

(225) 412-9955

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1407347586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1772",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705711772",
            "telephone_number": "225-412-9955",
            "fax_number": "225-412-9957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930B PRAYER HOUSE RD",
            "city": "WASHINGTON",
            "state": "LA",
            "postal_code": "705899113",
            "telephone_number": "225-412-9955",
            "fax_number": "225-412-9957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL DME",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-412-9955"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2494589",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Washington, LA
• Providers in Washington, LA by specialty
• Prosthetic/Orthotic Supplier in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.