Provider Demographics
NPI:1073856803
Name:PERSONAL CARE PRODUCTS, INC.
Entity Type:Organization
Organization Name:PERSONAL CARE PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STATLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-575-0302
Mailing Address - Street 1:1302 RUSTIQUE SQ
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-2231
Mailing Address - Country:US
Mailing Address - Phone:800-575-0302
Mailing Address - Fax:
Practice Address - Street 1:924 WINDBELL CIR
Practice Address - Street 2:SUITE C
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3125
Practice Address - Country:US
Practice Address - Phone:800-575-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010871402Medicaid
1243260001Medicare NSC