Provider Demographics
NPI:1427218544
Name:D K MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:D K MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-249-5034
Mailing Address - Street 1:242 FORT ZUMWALT SQ
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3064
Mailing Address - Country:US
Mailing Address - Phone:314-249-5034
Mailing Address - Fax:
Practice Address - Street 1:242 FORT ZUMWALT SQ
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3064
Practice Address - Country:US
Practice Address - Phone:314-249-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6172130001Medicare NSC