Provider Demographics
NPI:1295805232
Name:CHERUB MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:CHERUB MEDICAL SUPPLY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEHNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-604-5165
Mailing Address - Street 1:11217 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2751
Mailing Address - Country:US
Mailing Address - Phone:866-460-0440
Mailing Address - Fax:
Practice Address - Street 1:11217 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2751
Practice Address - Country:US
Practice Address - Phone:866-460-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1004454610AMedicaid
MO625904107Medicaid
KS4556560001Medicare NSC
KS4556560001Medicare PIN