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NPI Code Detail

MEDICARE: DOVE MASTECTOMY SUPPLY, LLC

MEDICARE: DOVE MASTECTOMY 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
1332B00000XDurable Medical Equipment & Medical Supplies17250374MO

General Provider Information

NPI Number : 1750406401
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOVE MASTECTOMY SUPPLY, LLC
Provider Business Mailing Address
First Line : 3016 COLLINGTON CT
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3960
Country : US
Telephone Number : 314-293-0974
Fax Number : 314-293-0974
Provider Business Practice Location Address
First Line : 3016 COLLINGTON CT
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3960
Country : US
Telephone Number : 314-293-0974
Fax Number : 314-293-0974
Authorized Official
Title or Position : OWNER
Name : MRS. MARY PATRICIA DOERR
Credential :
Telephone Number : 314-293-0974
Provider Enumeration Date : 03/20/2007
Last Update Date : 08/22/2020

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Directions to “DOVE MASTECTOMY SUPPLY, LLC ” Practice Location

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