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
769 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-4724
(573) 686-1589
(573) 686-1629
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
14868971
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
629892803
—
MO
05
—
=========
—
IL
Enumeration date
05/27/2006
Last updated
10/15/2025
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