Healthcare Provider Details

I. General information

NPI: 1922945633
Provider Name (Legal Business Name): JEREMY HIGBIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 IHLER RD
JEFFERSON CITY MO
65109-0643
US

IV. Provider business mailing address

705 IHLER RD
JEFFERSON CITY MO
65109-0643
US

V. Phone/Fax

Practice location:
  • Phone: 573-286-5270
  • Fax: 573-286-5270
Mailing address:
  • Phone: 573-286-5270
  • Fax: 573-286-5270

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:
Title or Position:
Credential:
Phone: