Provider Demographics
NPI:1417904814
Name:THERAPY SUPPORT INC
Entity Type:Organization
Organization Name:THERAPY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3M DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUSCELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-380-5105
Mailing Address - Street 1:2803 N OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4976
Mailing Address - Country:US
Mailing Address - Phone:417-887-5873
Mailing Address - Fax:417-380-5205
Practice Address - Street 1:2803 N OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4976
Practice Address - Country:US
Practice Address - Phone:417-887-5873
Practice Address - Fax:417-380-5205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO160813OtherBCBS
OH2043998Medicaid
OH156142OtherANTHEM
MO628955205Medicaid
MO1190450001Medicare NSC
1190450003Medicare ID - Type Unspecified
1190450004Medicare ID - Type Unspecified
OH2043998Medicaid