Provider Demographics
NPI:1235300674
Name:SIMPLY THICK, LLC
Entity Type:Organization
Organization Name:SIMPLY THICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-721-2023
Mailing Address - Street 1:200 S HANLEY RD
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3415
Mailing Address - Country:US
Mailing Address - Phone:888-721-2023
Mailing Address - Fax:800-508-2990
Practice Address - Street 1:200 S HANLEY RD
Practice Address - Street 2:SUITE 1102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3415
Practice Address - Country:US
Practice Address - Phone:888-721-2023
Practice Address - Fax:800-508-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100795170AMedicaid