=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194746552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIKE STUART ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 CORTNEY LN
-----------------------------------------------------
City | CRANE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65633-9192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-723-5241
-----------------------------------------------------
Fax | 417-723-5228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18656 BUSINESS 13
-----------------------------------------------------
City | BRANSON WEST
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-272-8064
-----------------------------------------------------
Fax | 417-272-0073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | MICHAEL STUART
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 417-272-8064
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 2006027988
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------