Provider Demographics
NPI:1528274875
Name:MIDWEST MEDICAL SUPPLY CO LLC
Entity type:Organization
Organization Name:MIDWEST MEDICAL SUPPLY CO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:REEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-291-2900
Mailing Address - Street 1:13400 LAKEFRONT DR
Mailing Address - Street 2:AOS
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1516
Mailing Address - Country:US
Mailing Address - Phone:800-858-5858
Mailing Address - Fax:800-545-0065
Practice Address - Street 1:13400 LAKEFRONT DR
Practice Address - Street 2:AOS
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1516
Practice Address - Country:US
Practice Address - Phone:800-858-5858
Practice Address - Fax:800-545-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2922480001Medicare NSC