MISSOURI CUSTOM ORTHOTICS LLC NPI 1871832600

NPI Information

NPI: 1871832600
Provider Name: MISSOURI CUSTOM ORTHOTICS LLC
Classification: Durable Medical Equipment & Medical Supplies - 332BC3200X
Entity Type: Organization

Specialization: Customized Equipment

Address:
12882 MANCHESTER RD
STE. 204
SAINT LOUIS, MO
ZIP 63131
Phone: (314) 821-2600
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MISSOURI CUSTOM ORTHOTICS LLC is a customized equipment durable medical equipment medical supplies in Saint Louis, MO. MISSOURI CUSTOM ORTHOTICS LLC NPI is 1871832600. The provider is registered as an organization entity type.

The provider's business location address is:

12882 MANCHESTER RD
STE. 204
SAINT LOUIS, MO
ZIP 63131-858
Phone: (314) 821-2600
Fax: (888) 770-2935

The provider's authorized official is Don Havey .
The authorized official title is Owner and has the following contact phone number (314) 821-2600.

The enumeration date for this NPI number is 2/14/2013 and was last updated on 7/10/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332BC3200X	Durable Medical Equipment & Medical Supplies	Customized Equipment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	6764900001	MEDICARE NSC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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