Provider Demographics
NPI:1902993504
Name:ALLEN MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:ALLEN MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:337-948-8611
Mailing Address - Street 1:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2087
Mailing Address - Country:US
Mailing Address - Phone:337-948-8611
Mailing Address - Fax:337-948-6138
Practice Address - Street 1:209 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5263
Practice Address - Country:US
Practice Address - Phone:337-948-8611
Practice Address - Fax:337-948-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1551422Medicaid
LA1551422Medicaid