# QUAD STATES MEDICAL REHAB AND SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407937121
- **Authorized official:** MR. ROSS D LOCKHART (50 SHAREHOLDER)
- **Authorized official phone:** (417) 646-2886

## Contact information

- **Practice address:** 107 WESMOR ST, CLINTON, MO 64735-1786
- **Practice address phone:** (417) 646-2886
- **Practice address fax:** (660) 885-2640
- **Mailing address:** PO BOX 564, OSCEOLA, MO 64776-0564
- **Mailing address phone:** (417) 646-2886
- **Mailing address fax:** (660) 885-2640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | 19368569 | MO | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 03/05/2008