Provider Demographics
NPI:1972534055
Name:SPEEDY MEDICAL SUPPLY, LLC.
Entity type:Organization
Organization Name:SPEEDY MEDICAL SUPPLY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEGOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-450-6411
Mailing Address - Street 1:11115 NEW HALLS FERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7611
Mailing Address - Country:US
Mailing Address - Phone:314-450-6411
Mailing Address - Fax:
Practice Address - Street 1:11115 NEW HALLS FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7611
Practice Address - Country:US
Practice Address - Phone:314-450-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC6437690332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5885210001Medicare NSC