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
1813 HERITAGE HILLS DR, WASHINGTON, MO 63090-4624
(636) 390-4200
(636) 390-4246
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
—
626339808
—
MO
Enumeration date
04/03/2007
Last updated
10/15/2025
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