Provider Demographics
NPI:1275517161
Name:SOUTH WEST MISSOURI HANDYCAP, INC.
Entity Type:Organization
Organization Name:SOUTH WEST MISSOURI HANDYCAP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-649-7968
Mailing Address - Street 1:29074 IMPATIENS LN
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-8141
Mailing Address - Country:US
Mailing Address - Phone:417-649-7968
Mailing Address - Fax:
Practice Address - Street 1:29074 IMPATIENS LN
Practice Address - Street 2:
Practice Address - City:CARL JUNCTION
Practice Address - State:MO
Practice Address - Zip Code:64834-8141
Practice Address - Country:US
Practice Address - Phone:417-649-7968
Practice Address - Fax:417-649-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO41806404-01OtherMISSOURI DEPT SPECIAL HEA
=========OtherINS