Organization
MED SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES C LINCOLN (PRESIDENT)
(573) 481-9625
Entity
Organization
Contact information
Practice address
3750 OSAGE BEACH PKWY STE 100, OSAGE BEACH, MO 65065-2292
(314) 645-7527
(314) 645-6676
Mailing address
1704 SOUTH BIG BEND BLVD, ST LOUIS, MO 63117-2402
(314) 645-7527
(314) 645-6676
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100794980A
MEDICAID
OK
05
—
622638401
—
MO
01
—
90006172
MEDICAID
KY
Enumeration date
09/19/2006
Last updated
12/15/2022
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