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
Update your record
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