Provider Demographics
NPI:1013232024
Name:MEDCO, LLC
Entity Type:Organization
Organization Name:MEDCO, LLC
Other - Org Name:SEMO MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-334-5994
Mailing Address - Street 1:254 S. MOUNT AUBURN RD.
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4918
Mailing Address - Country:US
Mailing Address - Phone:573-334-5994
Mailing Address - Fax:573-334-6250
Practice Address - Street 1:254 S. MOUNT AUBURN RD.
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4918
Practice Address - Country:US
Practice Address - Phone:573-334-5994
Practice Address - Fax:573-334-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6425530001Medicare NSC