1740271303 NPI number — EP EVANS DRUG, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740271303 NPI number — EP EVANS DRUG, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EP EVANS DRUG, 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:
PHYSICIANS MEDICAL EQUIPMENT AND SUPPLIES
Provider Other Organization Name Type Code:
3
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:
1740271303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E US HIGHWAY 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64744-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-876-5601
Provider Business Mailing Address Fax Number:
417-876-5604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E US HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64744-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-876-5601
Provider Business Practice Location Address Fax Number:
417-876-5604
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HALLFORD
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
417-876-5601

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 621255900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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