Organization
QUAD STATES MEDICAL REHAB AND SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROSS D LOCKHART (50 SHAREHOLDER)
(417) 646-2886
Entity
Organization
Contact information
Practice address
107 WESMOR ST, CLINTON, MO 64735-1786
(417) 646-2886
(660) 885-2640
Mailing address
PO BOX 564, OSCEOLA, MO 64776-0564
(417) 646-2886
(660) 885-2640
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
19368569
MO
Other
Enumeration date
10/18/2006
Last updated
03/05/2008
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