Healthcare Provider Details

I. General information

NPI: 1942355623
Provider Name (Legal Business Name): TOWN AND COUNTRY MOBILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E SPRINGFIELD RD
SAINT CLAIR MO
63077-1736
US

IV. Provider business mailing address

PO BOX 29
STANTON MO
63079-0029
US

V. Phone/Fax

Practice location:
  • Phone: 573-435-5774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00790264
License Number StateMO

VIII. Authorized Official

Name: MRS. CHRISTINE MARIE DWYER
Title or Position: PRESIDENT
Credential: LPN
Phone: 314-435-5774