Healthcare Provider Details

I. General information

NPI: 1427126242
Provider Name (Legal Business Name): A & B MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 GRACIE LN
MOSCOW MILLS MO
63362-1142
US

IV. Provider business mailing address

444 GRACIE LN
MOSCOW MILLS MO
63362-1142
US

V. Phone/Fax

Practice location:
  • Phone: 636-356-4803
  • Fax: 636-356-4605
Mailing address:
  • Phone: 636-356-4803
  • Fax: 636-356-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2009031587
License Number StateMO

VIII. Authorized Official

Name: ANGELA HENDERSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 636-356-4803