Organization
MISSOURI MED LLC
Active
Other names
MISSOURI MED, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE MCHUGH (OFFICE MANAGER)
(573) 335-3044
Entity
Organization
Contact information
Practice address
2215 BROADWAY, SUITE B, CAPE GIRARDEAU, MO 63701-4403
(573) 803-5500
(573) 803-5501
Mailing address
2215 BROADWAY ST, CAPE GIRARDEAU, MO 63701-4403
(573) 335-3044
(573) 335-6724
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
2018005320
MO
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176054
PK
—
05
—
600051690
—
MO
Enumeration date
01/24/2018
Last updated
03/03/2026
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