Provider Demographics
NPI:1164691283
Name:THERAPY SUPPORT, INC
Entity Type:Organization
Organization Name:THERAPY SUPPORT, INC
Other - Org Name:THERAPY SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:3M DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUSCELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-380-5105
Mailing Address - Street 1:2803 N OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4976
Mailing Address - Country:US
Mailing Address - Phone:417-887-5873
Mailing Address - Fax:417-380-5205
Practice Address - Street 1:2710 REED RD # 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-2341
Practice Address - Country:US
Practice Address - Phone:713-733-3803
Practice Address - Fax:713-733-8276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0101631332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2104879Medicaid
MO160813OtherANTHEM BC/BS
MO160813OtherANTHEM BC/BS
TX6101500001Medicare NSC