Provider Demographics
NPI:1477507036
Name:DUKE MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:DUKE MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-678-6692
Mailing Address - Street 1:300 BILTMORE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-8113
Mailing Address - Country:US
Mailing Address - Phone:888-678-6692
Mailing Address - Fax:888-550-7663
Practice Address - Street 1:300 BILTMORE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-8113
Practice Address - Country:US
Practice Address - Phone:888-678-6692
Practice Address - Fax:888-550-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO18327893332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806915500Medicaid
KS200262950-AMedicaid
HI552481-01Medicaid
MS7574878Medicaid
KY90008293Medicaid
TX1648107Medicaid
MO191703OtherBCBSMO
AR154579716Medicaid
OK200031550AMedicaid
MT5607082Medicaid
MO626137806Medicaid
AZ867765Medicaid
MT5607082Medicaid