MEDICARE: D K MEDICAL SUPPLY LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1427218544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D K MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	242 FORT ZUMWALT SQ
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-3064
Country	:	US
Telephone Number	:	314-249-5034
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 FORT ZUMWALT SQ
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-3064
Country	:	US
Telephone Number	:	314-249-5034
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBORAH JO MAXSON
Credential	:
Telephone Number	:	314-249-5034

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	04/28/2009

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