Provider Demographics
NPI:1427126242
Name:A & B MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:A & B MEDICAL SUPPLIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-356-4803
Mailing Address - Street 1:444 GRACIE LN
Mailing Address - Street 2:
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362-1142
Mailing Address - Country:US
Mailing Address - Phone:636-356-4803
Mailing Address - Fax:636-356-4605
Practice Address - Street 1:444 GRACIE LN
Practice Address - Street 2:
Practice Address - City:MOSCOW MILLS
Practice Address - State:MO
Practice Address - Zip Code:63362-1142
Practice Address - Country:US
Practice Address - Phone:636-356-4803
Practice Address - Fax:636-356-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009031587332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158760741Medicaid
MO625242904Medicaid
2637253OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO625242904Medicaid
IL=========001Medicaid