Healthcare Provider Details

I. General information

NPI: 1275517161
Provider Name (Legal Business Name): SOUTH WEST MISSOURI HANDYCAP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29074 IMPATIENS LN
CARL JUNCTION MO
64834-8141
US

IV. Provider business mailing address

29074 IMPATIENS LN
CARL JUNCTION MO
64834-8141
US

V. Phone/Fax

Practice location:
  • Phone: 417-649-7968
  • Fax: 417-649-0237
Mailing address:
  • Phone: 417-649-7968
  • Fax:

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: MR. ROBERT D SKOGLUND
Title or Position: PRESIDENT
Credential:
Phone: 417-649-7968