Provider Demographics
NPI:1467775528
Name:CMV-CDS,LLC
Entity Type:Organization
Organization Name:CMV-CDS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRE./CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-333-3268
Mailing Address - Street 1:825 W 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1236
Mailing Address - Country:US
Mailing Address - Phone:573-333-3268
Mailing Address - Fax:573-333-5368
Practice Address - Street 1:825 W 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1236
Practice Address - Country:US
Practice Address - Phone:573-333-3268
Practice Address - Fax:573-333-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care