Provider Demographics
NPI:1578732764
Name:THERAPY SUPPORT, INC
Entity Type:Organization
Organization Name:THERAPY SUPPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3M DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSCELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-380-5105
Mailing Address - Street 1:2803 N OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4976
Mailing Address - Country:US
Mailing Address - Phone:417-887-5873
Mailing Address - Fax:417-380-5205
Practice Address - Street 1:6610 FAIRFIELD DR
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-7513
Practice Address - Country:US
Practice Address - Phone:877-885-4325
Practice Address - Fax:419-661-1841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1588800332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2043998Medicaid
OH612577100OtherUS DEPT OF LABOR
OH160813OtherANTHEM SR. ADVANTAGE
MO160813OtherANTHEM BC/BS
OH156142OtherANTHEM BC/BS
OH156142OtherANTHEM BC/BS
OH=========OtherHUMANA GOLD CHOICE
OH612577100OtherUS DEPT OF LABOR
OH=========OtherADVANTRA FREEDOM
OH=========-005OtherMEDICAL MUTUAL