Provider Demographics
NPI:1932241213
Name:JOSEPH R. WOESTHAUS
Entity Type:Organization
Organization Name:JOSEPH R. WOESTHAUS
Other - Org Name:J AND W MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOESTHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-343-1700
Mailing Address - Street 1:257 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG LANE
Mailing Address - State:MO
Mailing Address - Zip Code:65590-4180
Mailing Address - Country:US
Mailing Address - Phone:417-345-1050
Mailing Address - Fax:417-345-1050
Practice Address - Street 1:257 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LONG LANE
Practice Address - State:MO
Practice Address - Zip Code:65590-4180
Practice Address - Country:US
Practice Address - Phone:417-345-1050
Practice Address - Fax:417-345-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17215421332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO625952601Medicaid
MO4549930001Medicare ID - Type Unspecified