Medsource of St. Louis, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

15710874 Issued in MO

Legal business name

MEDSOURCE OF ST. LOUIS, INC.

Practice address

3394 McKelvey Rd.
Suite 102
Saint Louis, MO 63044

Phone

(314) 966-1818

Fax

(314) 966-1001

NPI assigned

Jul 26, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mark Coffett

Title

President

Phone

(314) 966-1818

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1720001084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3394 MCKELVEY RD.",
            "address_2": "SUITE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-966-1818",
            "fax_number": "314-966-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3394 MCKELVEY RD.",
            "address_2": "SUITE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-966-1818",
            "fax_number": "314-966-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE OF ST. LOUIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "COFFETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-966-1818",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "15710874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626012405",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29678",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Durable Medical Equipment & Medical Supplies in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.