Healthcare Provider Details

I. General information

NPI: 1407852577
Provider Name (Legal Business Name): SUPPORT SURFACES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 MIDWEST INDUSTRIAL BLVD
SAINT LOUIS MO
63132-1610
US

IV. Provider business mailing address

10770 MIDWEST INDUSTRIAL BLVD
SAINT LOUIS MO
63132-1610
US

V. Phone/Fax

Practice location:
  • Phone: 314-426-2747
  • Fax: 314-428-5500
Mailing address:
  • Phone: 314-426-2747
  • Fax: 314-428-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD LISTON
Title or Position: OWNER/CFO
Credential:
Phone: 314-890-9900