Healthcare Provider Details

I. General information

NPI: 1447381694
Provider Name (Legal Business Name): OVERTURF HEALTH MART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 162
GIDEON MO
63848
US

IV. Provider business mailing address

HWY 162
GIDEON MO
63848
US

V. Phone/Fax

Practice location:
  • Phone: 573-448-5552
  • Fax: 573-448-3764
Mailing address:
  • Phone: 573-448-5552
  • Fax: 573-448-3764

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: RONNIE REHMS
Title or Position: OWNER
Credential:
Phone: 573-448-5552