NPIMap

Organization Active NPI

Town & Country Grocers of Fredericktown MD Inc

  • Durable Medical Equipment & Medical Supplies
  • Fredericktown, MO
National Provider Identifier
1174728745
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
006148 Issued in MO
Legal business name
TOWN & COUNTRY GROCERS OF FREDERICKTOWN MD INC
Practice address
210 E Murta St
Fredericktown, MO 63645-1018
Phone
(573) 783-2788
Fax
(573) 783-7899
NPI assigned
Jun 15, 2007
Last updated
Nov 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeremy I Leach, RPH
Title
Pharmacist-in-Charge
Phone
(573) 783-2788

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 006148 MO Primary

Addresses

Primary practice location

210 E Murta St
Fredericktown, MO 63645-1018

Mailing address

210 E Murta St
Fredericktown, MO 63645-1018
Phone (573) 783-2788

Other identifiers 1

IdentifierTypeStateIssuer
621894401MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Country Mart Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

210 E Murta St
Fredericktown, MO 63645
Phone (573) 783-2788

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258502400000",
    "number": "1174728745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E MURTA ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451018",
            "telephone_number": "573-783-2788",
            "fax_number": "573-783-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MURTA ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451018",
            "telephone_number": "573-783-2788",
            "fax_number": "573-783-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN & COUNTRY GROCERS OF FREDERICKTOWN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2009-11-18",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "573-783-2788",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "006148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621894401",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericktown, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.