Provider Demographics
NPI:1134189244
Name:FLEETMEDICALSUPPLINC
Entity type:Organization
Organization Name:FLEETMEDICALSUPPLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BIODUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-739-8009
Mailing Address - Street 1:3006 N LINDBERGH BLVD
Mailing Address - Street 2:705
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3242
Mailing Address - Country:US
Mailing Address - Phone:314-739-8009
Mailing Address - Fax:314-739-8014
Practice Address - Street 1:3006 N LINDBERGH BLVD
Practice Address - Street 2:705
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3242
Practice Address - Country:US
Practice Address - Phone:314-739-8009
Practice Address - Fax:314-739-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4520810001Medicare ID - Type UnspecifiedMEDICARE