Provider Demographics
NPI:1194746552
Name:MIKE STUART ENTERPRISES INC
Entity type:Organization
Organization Name:MIKE STUART ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-272-8064
Mailing Address - Street 1:18656 BUSINESS 13
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737
Mailing Address - Country:US
Mailing Address - Phone:417-272-8064
Mailing Address - Fax:417-272-0073
Practice Address - Street 1:104 CORTNEY LN
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633-9192
Practice Address - Country:US
Practice Address - Phone:417-723-5241
Practice Address - Fax:417-723-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MO20060279883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050485OtherPK
MO601962608Medicaid