Provider Demographics
NPI:1992007124
Name:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Entity type:Organization
Organization Name:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-3222
Mailing Address - Street 1:811 DAIRY ST
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-2660
Mailing Address - Country:US
Mailing Address - Phone:417-235-2253
Mailing Address - Fax:417-235-3985
Practice Address - Street 1:811 DAIRY ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2660
Practice Address - Country:US
Practice Address - Phone:417-235-2253
Practice Address - Fax:417-235-3985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KESSLER-HEASLEY ARTIFICIAL LIMB CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10333045335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620744805Medicaid