Healthcare Provider Details

I. General information

NPI: 1750488268
Provider Name (Legal Business Name): MED SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 OSAGE BEACH PKWY STE 100
OSAGE BEACH MO
65065-2292
US

IV. Provider business mailing address

1704 SOUTH BIG BEND BLVD
ST LOUIS MO
63117-2402
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-7527
  • Fax: 314-645-6676
Mailing address:
  • Phone: 314-645-7527
  • Fax: 314-645-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier90006172
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerMEDICAID
# 2
Identifier100794980A
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerMEDICAID
# 3
Identifier622638401
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MR. JAMES C LINCOLN
Title or Position: PRESIDENT
Credential:
Phone: 573-481-9625