Quad States Medical Rehab and Supply LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

19368569 Issued in MO

Legal business name

QUAD STATES MEDICAL REHAB AND SUPPLY LLC

Practice address

107 Wesmor St
Clinton, MO 64735-1786

Phone

(417) 646-2886

Fax

(660) 885-2640

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ross D Lockhart

Title

50 Shareholder

Phone

(417) 646-2886

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1407937121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 564",
            "city": "OSCEOLA",
            "state": "MO",
            "postal_code": "647760564",
            "telephone_number": "417-646-2886",
            "fax_number": "660-885-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WESMOR ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351786",
            "telephone_number": "417-646-2886",
            "fax_number": "660-885-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD STATES MEDICAL REHAB AND SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "LOCKHART",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "50  SHAREHOLDER",
        "authorized_official_telephone_number": "417-646-2886",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "MO",
            "license": "19368569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariana Politte, MA, LPC, NCC
• Tara D Poole, PA
• Courtney Louise Porter, M.S. CF-SLP
• Mallory Pritzel, M.S. CF-SLP
• Provcare Home Care Agency LLC
• Terri Rager-White, MS
• Carmen L Rathert
• Susan Raucstadt, LCSW
• Krista Reed, LPN
• Brian Lee Reger, PA-C

• Oxygen Equipment & Supplies (DME) in Clinton, MO
• Providers in Clinton, MO by specialty
• Oxygen Equipment & Supplies (DME) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; 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.