Healthcare Provider Details

I. General information

NPI: 1841351731
Provider Name (Legal Business Name): MIKE STUART ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18565 BUSINESS 13
BRANSON WEST MO
65737-9659
US

IV. Provider business mailing address

18565 BUSINESS 13
BRANSON WEST MO
65737-9659
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-8064
  • Fax: 417-272-0073
Mailing address:
  • Phone: 417-272-8064
  • Fax: 417-272-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006432
License Number StateMO

VIII. Authorized Official

Name: MICHAEL STUART
Title or Position: OWNER
Credential: RPH
Phone: 417-272-8064