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General NPI Number Information
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NPI Number | 1114035797
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Entity Type | Organization
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Legal Business Name | 3 FRIENDS LLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 12/31/2008
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Provider Practice Location Address
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Address Line | 161 S BENTON AVE SUITE 1
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City | MARSHALL
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State | MO
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Zip | 65340-1836
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Country | US
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Telephone | 660-831-5304
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Fax | 660-831-5304
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Provider Business Mailing Address
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Address Line | 161 S BENTON AVE SUITE 1
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City | MARSHALL
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State | MO
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Zip | 65340-1836
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Country | US
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Telephone | 660-831-5304
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Fax | 660-831-5304
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Authorized Official
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Title or Position | PARTNER
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Name | MS. JANICE KUEKER
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Credential | CFM
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Telephone | 660-831-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 17278171
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License Number State | MO
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