Healthcare Provider Details

I. General information

NPI: 1376552208
Provider Name (Legal Business Name): PERSONAL CARE PRODUCTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT SUITE 106
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

500 HUBER PARK CT SUITE 106
WELDON SPRING MO
63304-8683
US

V. Phone/Fax

Practice location:
  • Phone: 800-575-0302
  • Fax: 636-536-1242
Mailing address:
  • Phone: 800-575-0302
  • Fax: 636-536-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number17139112
License Number StateMO

VIII. Authorized Official

Name: MR. BRAD R STATLER
Title or Position: OWNER
Credential:
Phone: 636-536-4152