Organization
THERAPY SUPPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSCELL D. PAVLIN (MEDICARE MANAGER)
(417) 380-5105
Entity
Organization
Contact information
Practice address
4300 SIMON RD, BOARDMAN, OH 44512-1326
(330) 953-0553
(330) 953-0554
Mailing address
2803 N OAK GROVE AVE, SPRINGFIELD, MO 65803-4976
(417) 887-5873
(417) 380-5205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
HMER. 22583
OH
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
RSOX. 021908350
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056142
ANTHEM BLUE CROSS
OH
01
—
160813
ANTHEM BC/BS
MO
Enumeration date
04/30/2009
Last updated
05/04/2010
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