John M Fenton III, CPO
Individual provider Active NPI Prosthetic/Orthotic Supplier · Republic, MO
NPI 1376811489 · NPPES record last updated Dec 2, 2011
Key facts
- NPI
- 1376811489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthetic/Orthotic Supplier 335E00000X
- Practice address
- 838 Rachel St
Republic, MO 65738-1721 - Phone
- (417) 732-8483
- Fax
- (417) 732-8902
- NPI assigned
- Dec 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | Yes |
Addresses
Primary practice location
838 Rachel St
Republic, MO 65738-1721
Mailing address
838 Rachel St
Republic, MO 65738-1721
Phone (417) 732-8483
Other providers in Republic, MO
- Tara Ecklund
- Craig Brian Eden
- Caleb Eggleston
- Kimberly Emery
- Family Pharmacy Inc.
- Charla Fields
- Fincare,Inc
- Mary D Fletcher
- Latisha Jolene Florence
- Melissa Dawn Floyd
All providers in Republic, MO · Prosthetic/Orthotic Supplier in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.