Organization
KILGORE RESPIRATORY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED BIETSCH III (VICE PRESIDENT)
(573) 424-4652
Entity
Organization
Contact information
Practice address
3349 AMERICAN AVE, SUITE F, JEFFERSON CITY, MO 65109-1080
(573) 636-5011
(573) 636-5012
Mailing address
3103 W BROADWAY, SUITE 115, COLUMBIA, MO 65203-0497
(573) 442-8338
(573) 446-5008
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B0000X
MO
332BX2000X
Oxygen Equipment & Supplies (DME)
332BX200X
MO
Other
Enumeration date
04/03/2015
Last updated
04/28/2016
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