Provider Demographics
NPI:1669651410
Name:DRB MEDICAL, LLC
Entity Type:Organization
Organization Name:DRB MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOTIC CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA, CFO
Authorized Official - Phone:314-306-5652
Mailing Address - Street 1:21100 GOLDEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-6273
Mailing Address - Country:US
Mailing Address - Phone:636-377-2033
Mailing Address - Fax:877-265-0898
Practice Address - Street 1:21100 GOLDEN OAKS LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-6273
Practice Address - Country:US
Practice Address - Phone:636-377-2033
Practice Address - Fax:877-265-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626136402Medicaid
210429OtherBC/BS
IL=========001Medicaid
MO5062370001Medicare NSC