NPIMap

Organization Active NPI

Kilgore Inc

Doing business as Kilgore's Medical Pharmacy

  • Community/Retail Pharmacy
  • Columbia, MO
National Provider Identifier
1417901646
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2008000930 Issued in MO
Legal business name
KILGORE INC
Doing business as
Kilgore's Medical Pharmacy
Practice address
700 N Providence Rd
Columbia, MO 65203-4373
Phone
(573) 442-0194
Fax
(573) 443-8253
NPI assigned
May 20, 2006
Last updated
Jan 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

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

Authorized official

Name
Ann Bromstedt
Title
Owner
Phone
(573) 442-0194

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 2008000930 MO Primary
Long Term Care Pharmacy 3336L0003X NU
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

700 N Providence Rd
Columbia, MO 65203-4373

Mailing address

700 N Providence Rd
Columbia, MO 65203-4373
Phone (573) 442-0194

Other identifiers 5

IdentifierTypeStateIssuer
600587205MedicaidMO
2047047OtherPK
850587205MedicaidMO
600587208MedicaidMO
620587204MedicaidMO

Other names 1

  • KILGORE'S MEDICAL PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051215000057 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3375564503 2 other NPIs on this enrollment
Practice locations: Ashland, MO; Columbia, MO
O20100930013848 MO DME Supplier - PharmacyDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Medical Supply Company With Registered Pharmacist 3375564503 Practice locations: Columbia, MO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bartals Pharmacy7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1417901646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N PROVIDENCE RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034373",
            "telephone_number": "573-442-0194",
            "fax_number": "573-443-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N PROVIDENCE RD",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034373",
            "telephone_number": "573-442-0194",
            "fax_number": "573-443-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "BROMSTEDT",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-442-0194"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2008000930",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600587205",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047047",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850587205",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600587208",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620587204",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KILGORE'S MEDICAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; 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.