=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235206426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | N&S MEDICAL SUPPLY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 10/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W COLLEGE ST # 5
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63379-1124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-528-1533
-----------------------------------------------------
Fax | 636-528-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 TROJAN DR
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63379-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-528-1533
-----------------------------------------------------
Fax | 636-600-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPERATOR
-----------------------------------------------------
Name | MR. NATHANIEL BLAIR I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-528-1533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------