Enrollment ID	State	Provider type	PAC ID	Details
O20040929000382	MO	Part B Supplier - Mass Immunization (Roster Biller Only)	2466421102	20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Excelsior Springs, MO; Marshall, MO

National Provider Directory

Locations

300 SE Salem St
Oak Grove, MO 64075
Phone (816) 690-8600

Specialties & licenses 2

NPPES NPI Registry

Specialty (taxonomy)	Code	License	State	Primary
Durable Medical Equipment & Medical Supplies	332B00000X	2003022480	MO
Community/Retail Pharmacy	3336C0003X	2003022480	MO	Primary

Addresses

NPPES NPI Registry

Primary practice location

300 SE Salem St
Oak Grove, MO 64075-9299

Mailing address

52 E Arrow St
Marshall, MO 65340-2101
Phone (660) 886-5535

Other identifiers 1

NPPES NPI Registry

Identifier	Type	State	Issuer
600586929	Medicaid	MO

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 30, 2008.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1366520967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 E ARROW ST",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653402101",
            "telephone_number": "660-886-5535",
            "fax_number": "660-886-6320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SE SALEM ST",
            "city": "OAK GROVE",
            "state": "MO",
            "postal_code": "640759299",
            "telephone_number": "816-690-8600",
            "fax_number": "816-625-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CROSS PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "HARTWIG",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "BRENDEN",
        "authorized_official_title_or_position": "CO-PRESIDENT/CEO (OWNER)",
        "authorized_official_telephone_number": "660-886-5535",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "2003022480",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2003022480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600586929",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Grove, MO

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.