MEDICARE: SOUTH WEST MISSOURI HANDYCAP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41806404-01	OTHER	MO	MISSOURI DEPT SPECIAL HEA

General Provider Information

NPI Number	:	1275517161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH WEST MISSOURI HANDYCAP, INC.

Provider Business Mailing Address
First Line	:	29074 IMPATIENS LN
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-8141
Country	:	US
Telephone Number	:	417-649-7968
Fax Number	:

Provider Business Practice Location Address
First Line	:	29074 IMPATIENS LN
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-8141
Country	:	US
Telephone Number	:	417-649-7968
Fax Number	:	417-649-0237

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT D SKOGLUND
Credential	:
Telephone Number	:	417-649-7968

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	04/20/2008

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