Organization
STATE MEDICAL SUPPLY PROVIDER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SENDEROVICH (PESIDENT)
(314) 426-5903
Entity
Organization
Contact information
Practice address
9109 LACKLAND RD, SAINT LOUIS, MO 63114-5410
(314) 426-5903
(314) 890-2110
Mailing address
9109 LACKLAND RD, SAINT LOUIS, MO 63114-5410
(314) 426-5903
(314) 890-2110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
17769558
MO
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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