OrganizationGreenway Medical Inc.(Diabetes Source Rx)Durable Medical Equipment & Medical SuppliesSuppliersPractice Address803 Coolidge Blvd, Suite 128, Lafayette, LA 70503-2376(337) 267-7470PECOS EnrollmentBased on the most recent information from CMS, provider Greenway Medical Inc. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1609865773Provider TypeOrganizationFull NameGreenway Medical Inc.Other NameDiabetes Source RxSubpartNoEnumeration Date10/20/2005Last Updated4/23/2009Contact InformationPractice LocationPractice Address803 Coolidge Blvd, Suite 128, Lafayette, LA 70503-2376Phone(337) 267-7470Fax(866) 794-5729Mailing LocationMailing AddressPO Box 52884, Lafayette, LA 70505-2884Phone(337) 267-7470Fax(866) 794-5729Authorized OfficialNameMouton, Molly (Vice President)Phone(337) 267-7470Provider TaxonomiesCodeDescriptionLicenseCode332B00000XPrimaryDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID011633701DescriptionMedicaidIssuerUnlistedTexasIDG9723DescriptionOtherIssuerBCBS OF LOUISIANALouisianaID010164401DescriptionMedicaidIssuerUnlistedTexasID1467537DescriptionMedicaidIssuerUnlistedLouisianaID519779DescriptionOtherIssuerBCBS OF TEXASTexas