Healthcare Provider Details

I. General information

NPI: 1194758516
Provider Name (Legal Business Name): MEDIC HOUSE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S CRYSLER AVE
INDEPENDENCE MO
64052-4034
US

IV. Provider business mailing address

1101 S CRYSLER AVE
INDEPENDENCE MO
64052-4034
US

V. Phone/Fax

Practice location:
  • Phone: 816-461-7676
  • Fax: 816-461-6105
Mailing address:
  • Phone: 816-461-7676
  • Fax: 816-461-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MISS SHELLY WOODSON
Title or Position: MANAGER
Credential:
Phone: 816-461-7676