Mike Stuart Enterprises Inc
Organization Active NPI Community/Retail Pharmacy · Crane, MO
NPI 1194746552 · NPPES record last updated Apr 23, 2024
Key facts
- NPI
- 1194746552
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2006027988 (MO)
- Legal business name
- MIKE STUART ENTERPRISES INC
- Practice address
- 104 Cortney LN
Crane, MO 65633-9192 - Phone
- (417) 723-5241
- Fax
- (417) 723-5228
- NPI assigned
- Jul 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Stuart, RPH
- Title
- Owner President
- Phone
- (417) 272-8064
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091002000512 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 5193861201 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Branson, MO; Branson West, MO; Crane, MO; Forsyth, MO; Willow Springs, MO |
National Provider Directory
Locations
18656 Business 13
Branson West, MO 65737
104 Cortney Ln
Crane, MO 65633
Phone (417) 723-5227
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2006027988 | MO | Yes |
Addresses
Primary practice location
104 Cortney LN
Crane, MO 65633-9192
Mailing address
18656 Business 13
Branson West, MO 65737
Phone (417) 272-8064
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2050485 | Other | PK | |
| 601962608 | Medicaid | MO |
Other names
- LAKELAND PHARMACY
Other providers in Crane, MO
- Lester E Cox Medical Centers
- Lester E Cox Medical Centers
- Lester E Cox Medical Centers
- Meadowlark Gardens LLC
- Carolyn J Mease
- Mike Stuart Enterprises, Inc.
- N & R of Crane LLC
- Ernesto T Padre
- Rolling Hills Home Care LLC
- School District R 3 Crane
All providers in Crane, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.