Provider Demographics
NPI:1740458611
Name:THERAPY SUPPORT, INC.
Entity type:Organization
Organization Name:THERAPY SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3M DIRECTOR
Authorized Official - Prefix:MRS
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 1:295 S ALEX RD
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1910
Practice Address - Country:US
Practice Address - Phone:877-885-4325
Practice Address - Fax:937-865-6595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1456800332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH612577100OtherUS DEPT OF LABOR
OH160813OtherANTHEM SR. ADVANTAGE
MO160813OtherANTHEM BC/BS
OH2043998Medicaid
OH156142OtherANTHEM BC/BS
OH=========OtherTRICARE STANDARD
MO160813OtherANTHEM BC/BS
OH=========OtherADVANTRA FREEDOM
OH=========-003OtherMEDICAL MUTUAL
OH=========OtherTRICARE STANDARD