Provider Demographics
NPI:1831325836
Name:MEDICAL 1 PATIENT SERVICES
Entity type:Organization
Organization Name:MEDICAL 1 PATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-291-0503
Mailing Address - Street 1:PO BOX 87356
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-8356
Mailing Address - Country:US
Mailing Address - Phone:225-291-0503
Mailing Address - Fax:225-291-0510
Practice Address - Street 1:11768 S HARRELLS FERRY RD
Practice Address - Street 2:SUITE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2394
Practice Address - Country:US
Practice Address - Phone:225-291-0503
Practice Address - Fax:225-291-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1770114001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5934880001Medicare NSC