State Medical Supply Provider, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

17769558 Issued in MO

Legal business name

STATE MEDICAL SUPPLY PROVIDER, INC

Practice address

9109 Lackland Rd
Saint Louis, MO 63114-5410

Phone

(314) 426-5903

Fax

(314) 890-2110

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. David Senderovich

Title

Pesident

Phone

(314) 426-5903

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720290281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9109 LACKLAND RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631145410",
            "telephone_number": "314-426-5903",
            "fax_number": "314-890-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9109 LACKLAND RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631145410",
            "telephone_number": "314-426-5903",
            "fax_number": "314-890-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE MEDICAL SUPPLY PROVIDER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SENDEROVICH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PESIDENT",
        "authorized_official_telephone_number": "314-426-5903",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "17769558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe Stason, PHARMD
• Jacob Andrew Stason, PHARMD
• Deanna Marie Stassi, M.A.
• Jessica Kathryn Staszak, MD
• Stat J in Home Care LLC
• State of Missouri
• State of Missouri
• State of Missouri
• State of Missouri
• State of Missouri

• 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.