Provider Demographics
NPI:1578206645
Name:EP EVANS DRUG, INC
Entity Type:Organization
Organization Name:EP EVANS DRUG, INC
Other - Org Name:PHYSICIANS MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-876-5601
Mailing Address - Street 1:200 E US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPG
Mailing Address - State:MO
Mailing Address - Zip Code:64744-1926
Mailing Address - Country:US
Mailing Address - Phone:417-876-5601
Mailing Address - Fax:417-876-5604
Practice Address - Street 1:107 S OAK ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3436
Practice Address - Country:US
Practice Address - Phone:417-876-5601
Practice Address - Fax:417-876-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621255900Medicaid