Provider Demographics
NPI:1376552208
Name:PERSONAL CARE PRODUCTS, INC.
Entity Type:Organization
Organization Name:PERSONAL CARE PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:STATLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-536-4152
Mailing Address - Street 1:500 HUBER PARK CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8683
Mailing Address - Country:US
Mailing Address - Phone:800-575-0302
Mailing Address - Fax:636-536-1242
Practice Address - Street 1:500 HUBER PARK CT
Practice Address - Street 2:SUITE 106
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8683
Practice Address - Country:US
Practice Address - Phone:800-575-0302
Practice Address - Fax:636-536-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17139112332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440014300Medicaid
AR136132716Medicaid
MT5606056Medicaid
IN200233320Medicaid
NM30905575Medicaid
TX016760301Medicaid
VA010210330Medicaid
CO97634255Medicaid
IA0530246Medicaid
OH2515513Medicaid
KY7100014190Medicaid
ID805254300Medicaid
WA9047432Medicaid
ID805254300Medicaid
MT5606056Medicaid