Provider Demographics
NPI:1043454093
Name:THE MEDICAL DEPOT,LLC
Entity type:Organization
Organization Name:THE MEDICAL DEPOT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-322-2440
Mailing Address - Street 1:3016 JEAN LAFITTE PKY.
Mailing Address - Street 2:STE.B
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043
Mailing Address - Country:US
Mailing Address - Phone:504-322-2440
Mailing Address - Fax:504-333-6077
Practice Address - Street 1:3016 JEAN LAFITTE PKY.
Practice Address - Street 2:STE.B
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043
Practice Address - Country:US
Practice Address - Phone:504-322-2440
Practice Address - Fax:504-333-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1798746Medicaid
LA1798746Medicaid