Provider Demographics
NPI:1134107089
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 CFO
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:800-718-0407
Mailing Address - Street 1:1314 W SCHATZ LN
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7194
Mailing Address - Country:US
Mailing Address - Phone:800-718-0407
Mailing Address - Fax:866-297-2413
Practice Address - Street 1:1314 W SCHATZ LN
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7194
Practice Address - Country:US
Practice Address - Phone:800-718-0407
Practice Address - Fax:866-297-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-01
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP 00317332B00000X
NVMP00317332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5622000001Medicare NSC
CA5622000002Medicare NSC