MEDICARE: LTC PROVIDERS, 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	15522814	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356382790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LTC PROVIDERS, INC

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-0069
Country	:	US
Telephone Number	:	573-860-6800
Fax Number	:	573-860-6801

Provider Business Practice Location Address
First Line	:	115 PROGRESS PKWY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-2359
Country	:	US
Telephone Number	:	573-860-6800
Fax Number	:	573-860-6801

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. JEFFREY D LOCK
Credential	:
Telephone Number	:	573-860-6800

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/27/2011

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Directions to “LTC PROVIDERS, INC ” Practice Location

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