Provider Demographics
NPI:1114035797
Name:3 FRIENDS LLC
Entity Type:Organization
Organization Name:3 FRIENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEKER
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:660-831-5304
Mailing Address - Street 1:161 S BENTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1836
Mailing Address - Country:US
Mailing Address - Phone:660-831-5304
Mailing Address - Fax:660-831-5304
Practice Address - Street 1:161 S BENTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1836
Practice Address - Country:US
Practice Address - Phone:660-831-5304
Practice Address - Fax:660-831-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17278171335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO624973905Medicaid
MO1306080001Medicare NSC