Healthcare Provider Details

I. General information

NPI: 1497279517
Provider Name (Legal Business Name): PERFORMANCE PLUS MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N WOODBINE RD
SAINT JOSEPH MO
64506-3667
US

IV. Provider business mailing address

1802 N WOODBINE RD
SAINT JOSEPH MO
64506-3667
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-5113
  • Fax: 816-232-0453
Mailing address:
  • Phone: 816-232-5113
  • Fax: 816-232-0453

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: ALLYN SMITH
Title or Position: OWNER
Credential:
Phone: 816-232-5113