PCG Medical,LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PCG MEDICAL,LLC

Practice address

3350 Ridgelake Dr Ste 280
Metairie, LA 70002-3873

Phone

(504) 836-3899

Fax

(504) 836-3899

NPI assigned

May 19, 2006

Organization subpart

Yes

Parent organization

PCG MEDICAL REVOCABLE TRUST DATE AUGUST 3, 2005As reported in NPPES

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

Authorized official

Name

Micheline Stephens, OWNER

Title

Owner

Phone

(504) 836-3899

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1811941487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 RIDGELAKE DR",
            "address_2": "SUITE NUMBER 200",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700023831",
            "telephone_number": "504-836-3899",
            "fax_number": "504-836-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 RIDGELAKE DR STE 280",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700023873",
            "telephone_number": "504-836-3899",
            "fax_number": "504-836-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCG MEDICAL,LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PCG MEDICAL REVOCABLE TRUST DATE AUGUST 3, 2005",
        "enumeration_date": "2006-05-19",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "MICHELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-836-3899",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1529273",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Metairie, LA
• Providers in Metairie, LA by specialty
• Durable Medical Equipment & Medical Supplies in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.