Provider Demographics
NPI:1679745012
Name:FOURCO, INC.
Entity type:Organization
Organization Name:FOURCO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOURNET
Authorized Official - Suffix:
Authorized Official - Credentials:PT ADV
Authorized Official - Phone:337-828-0989
Mailing Address - Street 1:1524 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3723
Mailing Address - Country:US
Mailing Address - Phone:337-828-0989
Mailing Address - Fax:337-828-3414
Practice Address - Street 1:848 MARGUERITE ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1837
Practice Address - Country:US
Practice Address - Phone:985-384-0689
Practice Address - Fax:985-384-2689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOURCO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1216364Medicaid
LA=========0OtherBLUE CROSS OF LOUISIANA
LA4999340003Medicare NSC