Provider Demographics
NPI:1871666552
Name:MASON'S MEMORY DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:MASON'S MEMORY DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THORNBRUGHMASON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:785-242-8882
Mailing Address - Street 1:2534 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-9555
Mailing Address - Country:US
Mailing Address - Phone:785-242-8882
Mailing Address - Fax:785-242-8305
Practice Address - Street 1:2534 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-9555
Practice Address - Country:US
Practice Address - Phone:785-242-8882
Practice Address - Fax:785-242-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies