Provider Demographics
NPI:1114008729
Name:SEMO MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:SEMO MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-6600
Mailing Address - Street 1:812 LESTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1615
Mailing Address - Country:US
Mailing Address - Phone:573-888-6600
Mailing Address - Fax:573-888-6655
Practice Address - Street 1:1417 N MOUNT AUBURN RD
Practice Address - Street 2:STE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-334-5994
Practice Address - Fax:573-334-6250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMO MEDICAL EQUIPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626314207Medicaid
MO626314207Medicaid