1477507036 NPI number — DUKE MEDICAL SUPPLY, INC

Table of content: (NPI 1477507036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477507036 NPI number — DUKE MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUKE MEDICAL SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477507036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 BILTMORE DR
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
FENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63026-8113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-678-6692
Provider Business Mailing Address Fax Number:
888-550-7663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BILTMORE DR
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
FENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63026-8113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-678-6692
Provider Business Practice Location Address Fax Number:
888-550-7663
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAVANAGH
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-678-6692

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  18327893 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806915500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200262950-A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 552481-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7574878 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90008293 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1648107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191703 . This is a "BCBSMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 154579716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200031550A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5607082 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 626137806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 867765 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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