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NPI Code Detail

MEDICARE: CENTRAL STATES MEDICAL DISTRIBUTORS LLC

MEDICARE: CENTRAL STATES MEDICAL DISTRIBUTORS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BC3200XCustomized Equipment (DME)MO

General Provider Information

NPI Number : 1376082156
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL STATES MEDICAL DISTRIBUTORS LLC
Provider Business Mailing Address
First Line : 9006 NE 80TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64158-7604
Country : US
Telephone Number : 816-616-3535
Fax Number :
Provider Business Practice Location Address
First Line : 9006 NE 80TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64158-7604
Country : US
Telephone Number : 816-616-3535
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BRIDGET MUSSORICI
Credential :
Telephone Number : 816-616-3535
Provider Enumeration Date : 02/14/2017
Last Update Date : 02/14/2017

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Directions to “CENTRAL STATES MEDICAL DISTRIBUTORS LLC ” Practice Location

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