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
1800 CAPE LACROIX RD, CAPE GIRARDEAU, MO 63701-9634
(573) 651-6521
(573) 651-4093
Mailing address
555 E NORTH LN STE 5075, CONSHOHOCKEN, PA 19428-2233
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982859286
—
MO
Enumeration date
12/01/2008
Last updated
03/27/2025
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