Provider Demographics
NPI:1497279517
Name:PERFORMANCE PLUS MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:PERFORMANCE PLUS MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-5113
Mailing Address - Street 1:1802 N WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3667
Mailing Address - Country:US
Mailing Address - Phone:816-232-5113
Mailing Address - Fax:816-232-0453
Practice Address - Street 1:1802 N WOODBINE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3667
Practice Address - Country:US
Practice Address - Phone:816-232-5113
Practice Address - Fax:816-232-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620065988Medicaid