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General NPI Number Information
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NPI Number | 1124354576
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Entity Type | Organization
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Legal Business Name | CMV HOME MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 825 W 3RD ST STE A
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1236
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Country | US
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Telephone | 537-333-3784
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Fax | 573-333-3785
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Provider Business Mailing Address
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Address Line | 825 W 3RD ST STE A
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1236
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Country | US
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Telephone | 537-333-3784
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Fax | 573-333-3785
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Authorized Official
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Title or Position | MEMBER
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Name | WILLIAM JEFFERY MONTGOMERY
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Credential |
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Telephone | 573-333-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 2001010194
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License Number State | MO
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