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Organization

MEDIC HOUSE INCORPORATED

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS SHELLY WOODSON (MANAGER)
(816) 461-7676
Entity
Organization

Contact information

Practice address
1101 S CRYSLER AVE, INDEPENDENCE, MO 64052-4034
(816) 461-7676
(816) 461-6105
Mailing address
1101 S CRYSLER AVE, INDEPENDENCE, MO 64052-4034
(816) 461-7676
(816) 461-6105

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332BX2000X
Oxygen Equipment & Supplies (DME)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
06695018
BCBS KC PROVIDER NUMBER
MO
05
620280412
MO
Enumeration date
07/09/2006
Last updated
06/23/2009
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