Provider Demographics
NPI:1578454351
Name:METAIRIE MEDICAL LLC
Entity type:Organization
Organization Name:METAIRIE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-354-8662
Mailing Address - Street 1:3350 RIDGELAKE DR STE 273
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3836
Mailing Address - Country:US
Mailing Address - Phone:504-354-8662
Mailing Address - Fax:504-313-1540
Practice Address - Street 1:3350 RIDGELAKE DR STE 273
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3836
Practice Address - Country:US
Practice Address - Phone:504-354-8662
Practice Address - Fax:504-313-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies