Provider Demographics
NPI:1346310117
Name:SEMO MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:SEMO MEDICAL EQUIPMENT LLC
Other - Org Name:MITCHELL OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-6600
Mailing Address - Street 1:812 LESTER ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1615
Mailing Address - Country:US
Mailing Address - Phone:573-888-1773
Mailing Address - Fax:573-888-2105
Practice Address - Street 1:812 LESTER ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1615
Practice Address - Country:US
Practice Address - Phone:573-888-1773
Practice Address - Fax:573-888-2105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEMO MEDICAL EQUIPMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626314306Medicaid
MO626314306Medicaid