Provider Demographics
NPI:1952418717
Name:SUREPOINT MEDICAL LLC
Entity Type:Organization
Organization Name:SUREPOINT MEDICAL LLC
Other - Org Name:SUREPOINT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-550-4153
Mailing Address - Street 1:3235 OUSDAHL RD
Mailing Address - Street 2:STE B
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4366
Mailing Address - Country:US
Mailing Address - Phone:866-351-2636
Mailing Address - Fax:866-235-7541
Practice Address - Street 1:3235 OUSDAHL RD
Practice Address - Street 2:STE B
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4366
Practice Address - Country:US
Practice Address - Phone:866-351-2636
Practice Address - Fax:866-235-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-129903336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626252704Medicaid
2027353OtherPK
KS200375780AMedicaid
MO626252704Medicaid