MEDICARE: SUPPORT SURFACES, 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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105353	OTHER	MO	BLUE CROSS BLUE SHIELD
2	8655	OTHER	MO	HEALTHCARE USA
3	33534	OTHER	MO	GHP INSURANCE
4	118374	OTHER	MO	HEALTHLINK INSURANCE

General Provider Information

NPI Number	:	1407852577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SURFACES, INC

Provider Business Mailing Address
First Line	:	10770 MIDWEST INDUSTRIAL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1610
Country	:	US
Telephone Number	:	314-426-2747
Fax Number	:	314-428-5500

Provider Business Practice Location Address
First Line	:	10770 MIDWEST INDUSTRIAL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1610
Country	:	US
Telephone Number	:	314-426-2747
Fax Number	:	314-428-5500

Authorized Official
Title or Position	:	OWNER/CFO
Name	:	MR. RICHARD LISTON
Credential	:
Telephone Number	:	314-890-9900

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/20/2008

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Directions to “SUPPORT SURFACES, INC ” Practice Location

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