Provider Demographics
NPI:1043496508
Name:MEDCARE HOME MEDICAL LLC
Entity Type:Organization
Organization Name:MEDCARE HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STRINGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-459-5500
Mailing Address - Street 1:1936 E SUNSHINE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1503
Mailing Address - Country:US
Mailing Address - Phone:417-881-6300
Mailing Address - Fax:417-882-0255
Practice Address - Street 1:1936 E SUNSHINE
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1503
Practice Address - Country:US
Practice Address - Phone:417-881-6300
Practice Address - Fax:417-882-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20045603332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5622000001Medicare NSC