Healthcare Provider Details

I. General information

NPI: 1134189244
Provider Name (Legal Business Name): FLEETMEDICALSUPPLINC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 N LINDBERGH BLVD 705
SAINT ANN MO
63074-3242
US

IV. Provider business mailing address

3006 N LINDBERGH BLVD 705
SAINT ANN MO
63074-3242
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-8009
  • Fax: 314-739-8014
Mailing address:
  • Phone: 314-739-8009
  • Fax: 314-739-8014

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. BIODUN A ATU
Title or Position: PRESIDENT/CEO
Credential:
Phone: 314-739-8009