| East Bayou Medical Supply | |
|
204 Energy Pkwy Suite B Lafayette LA 70508-3816 | |
| (337) 269-0136 | |
| (337) 233-8525 |
| Full Name | East Bayou Medical Supply |
|---|---|
| Speciality | Clinic/center |
| Location | 204 Energy Pkwy, Lafayette, Louisiana |
| Authorized Official Name and Position | Paul Eugene Fenn (PHYSICIAN) |
| Authorized Official Contact | 3372690136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Bayou Medical Supply 204 Energy Pkwy Suite B Lafayette LA 70508-3816 Ph: (337) 269-0136 | East Bayou Medical Supply 204 Energy Pkwy Suite B Lafayette LA 70508-3816 Ph: (337) 269-0136 |
| NPI Number | 1912289224 |
|---|---|
| Provider Enumeration Date | 09/13/2011 |
| Last Update Date | 09/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912289224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MD200825 (Louisiana) | Primary |
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