Provider Demographics
NPI:1407852577
Name:SUPPORT SURFACES, INC
Entity Type:Organization
Organization Name:SUPPORT SURFACES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-890-9900
Mailing Address - Street 1:10770 MIDWEST INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1610
Mailing Address - Country:US
Mailing Address - Phone:314-426-2747
Mailing Address - Fax:314-428-5500
Practice Address - Street 1:10770 MIDWEST INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1610
Practice Address - Country:US
Practice Address - Phone:314-426-2747
Practice Address - Fax:314-428-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105353OtherBLUE CROSS BLUE SHIELD
MO8655OtherHEALTHCARE USA
MO33534OtherGHP INSURANCE
MO118374OtherHEALTHLINK INSURANCE
MO=========OtherTRICARE INSURANCE
MO118374OtherHEALTHLINK INSURANCE
MO8655OtherHEALTHCARE USA
MO=========REHOtherMERCY INSURANCE