1578608584 NPI number — MARK TWAIN OXYGEN & MEDICAL EQUIPMENT LLC

Table of content: MR. CHARLES LEWIS LAMBERT CRNA (NPI 1457418907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578608584 NPI number — MARK TWAIN OXYGEN & MEDICAL EQUIPMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK TWAIN OXYGEN & MEDICAL EQUIPMENT LLC
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:
1578608584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6464 INTERSTATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-6759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-221-2402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6464 INTERSTATE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-6759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-221-2402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEMIS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-221-2402

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  LC0541704 , 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: 613566 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 182410 . This is a "BLUE CROSS BLUE SHIELD MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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