Healthcare Provider Details

I. General information

NPI: 1427218544
Provider Name (Legal Business Name): D K MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 FORT ZUMWALT SQ
O FALLON MO
63366-3064
US

IV. Provider business mailing address

242 FORT ZUMWALT SQ
O FALLON MO
63366-3064
US

V. Phone/Fax

Practice location:
  • Phone: 314-249-5034
  • Fax:
Mailing address:
  • Phone: 314-249-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH JO MAXSON
Title or Position: OWNER
Credential:
Phone: 314-249-5034