Organization
PROVIDER PLUS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY RUSSALESI (CCO)
(484) 246-9499
Entity
Organization
Contact information
Practice address
102 SMITH AVE, SIKESTON, MO 63801-5240
(573) 472-7975
(573) 472-2356
Mailing address
555 E NORTH LN STE 5075, CONSHOHOCKEN, PA 19428-2490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376850420
—
MO
Enumeration date
09/10/2010
Last updated
10/15/2025
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