Healthcare Provider Details

I. General information

NPI: 1801723648
Provider Name (Legal Business Name): STONE BRIDGE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 WOLF CREEK RD
PACIFIC MO
63069-5247
US

IV. Provider business mailing address

PO BOX 1719
COLUMBIA MO
65205-1719
US

V. Phone/Fax

Practice location:
  • Phone: 239-848-5159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WILLIAM DOWELL
Title or Position: PRINCIPAL
Credential:
Phone: 239-848-5159