Organization
MED RESOURCES RETAIL, LLC
Active
Other names
Med Resources Retail
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF BRAUN (EXECUTIVE DIRECTOR)
(636) 733-7200
Entity
Organization
Contact information
Practice address
15464 OLIVE BOULEVARD, SUITE 200, CHESTERFIELD, MO 63017-1719
(636) 530-4500
(636) 530-4577
Mailing address
15464 OLIVE BOULEVARD, SUITE 200, CHESTERFIELD, MO 63017-1719
(636) 530-4500
(636) 530-4577
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
626238505
—
MO
Enumeration date
09/16/2005
Last updated
02/18/2021
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