Healthcare Provider Details

I. General information

NPI: 1114035797
Provider Name (Legal Business Name): 3 FRIENDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 S BENTON AVE SUITE 1
MARSHALL MO
65340-1836
US

IV. Provider business mailing address

161 S BENTON AVE SUITE 1
MARSHALL MO
65340-1836
US

V. Phone/Fax

Practice location:
  • Phone: 660-831-5304
  • Fax: 660-831-5304
Mailing address:
  • Phone: 660-831-5304
  • Fax: 660-831-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number17278171
License Number StateMO

VIII. Authorized Official

Name: MS. JANICE KUEKER
Title or Position: PARTNER
Credential: CFM
Phone: 660-831-5304