Provider Demographics
NPI:1659515815
Name:THERAPY SUPPORT, INC.
Entity Type:Organization
Organization Name:THERAPY SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE MANAGER
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 1:4300 SIMON RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-1326
Practice Address - Country:US
Practice Address - Phone:330-953-0553
Practice Address - Fax:330-953-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER. 22583332B00000X
OHRSOX. 021908350332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO160813OtherANTHEM BC/BS
OH056142OtherANTHEM BLUE CROSS
OH1190450008Medicare NSC