Provider Demographics
NPI:1689010209
Name:PAR MEDICAL INC
Entity type:Organization
Organization Name:PAR MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:KITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-455-3853
Mailing Address - Street 1:12 B SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062
Mailing Address - Country:US
Mailing Address - Phone:504-464-0677
Mailing Address - Fax:504-464-0677
Practice Address - Street 1:156 APPLE AVENUE.
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476
Practice Address - Country:US
Practice Address - Phone:601-788-2880
Practice Address - Fax:601-788-2880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAR MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-22
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04024846Medicaid