Provider Demographics
NPI:1538201611
Name:FERGUSONS LA TIENDA INC
Entity type:Organization
Organization Name:FERGUSONS LA TIENDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER & FITTER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:318-675-0180
Mailing Address - Street 1:PO BOX 6689
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6689
Mailing Address - Country:US
Mailing Address - Phone:318-675-0180
Mailing Address - Fax:318-675-0190
Practice Address - Street 1:2601 LINE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3023
Practice Address - Country:US
Practice Address - Phone:318-675-0180
Practice Address - Fax:318-675-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1322059Medicaid
LA1322059Medicaid