Provider Demographics
NPI:1558884544
Name:BOONE HEALTH SUPPLIES
Entity Type:Organization
Organization Name:BOONE HEALTH SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-295-7044
Mailing Address - Street 1:303 N STADIUM BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1493
Mailing Address - Country:US
Mailing Address - Phone:816-295-7044
Mailing Address - Fax:
Practice Address - Street 1:303 N STADIUM BLVD FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1493
Practice Address - Country:US
Practice Address - Phone:816-295-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies