Healthcare Provider Details

I. General information

NPI: 1134107089
Provider Name (Legal Business Name): MEDCARE HOME MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 W SCHATZ LN
NIXA MO
65714-7194
US

IV. Provider business mailing address

1314 W SCHATZ LN
NIXA MO
65714-7194
US

V. Phone/Fax

Practice location:
  • Phone: 800-718-0407
  • Fax: 866-297-2413
Mailing address:
  • Phone: 800-718-0407
  • Fax: 866-297-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMP 00317
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMP00317
License Number StateNV

VIII. Authorized Official

Name: MR. RUSSELL ALLEN STRINGFELLOW
Title or Position: MANAGING MEMBER CFO
Credential:
Phone: 800-718-0407