Provider Demographics
NPI:1235116849
Name:ACINUS MEDICAL LLC
Entity Type:Organization
Organization Name:ACINUS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-229-1811
Mailing Address - Street 1:400 SE BRIZENDINE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-6241
Mailing Address - Country:US
Mailing Address - Phone:816-229-1811
Mailing Address - Fax:816-229-2061
Practice Address - Street 1:400 SE BRIZENDINE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-6241
Practice Address - Country:US
Practice Address - Phone:816-229-1811
Practice Address - Fax:816-229-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6697332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34992015OtherBCBS OF KC
SC5330310001Medicare ID - Type Unspecified