Healthcare Provider Details

I. General information

NPI: 1275008047
Provider Name (Legal Business Name): SEGO MED SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW 10TH ST
BLUE SPRINGS MO
64015-3749
US

IV. Provider business mailing address

401 NW 10TH ST
BLUE SPRINGS MO
64015-3749
US

V. Phone/Fax

Practice location:
  • Phone: 833-788-1865
  • Fax: 918-729-8004
Mailing address:
  • Phone: 833-788-1865
  • Fax: 918-729-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LISA J WEBB
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 833-788-1865