Billy Joe Medlen
Individual provider Active NPI Contractor · Crocker, MO
NPI 1881476091 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1881476091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 20445 Bangor Rd
Crocker, MO 65452-8239 - Phone
- (573) 528-4153
- NPI assigned
- Oct 23, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | |||
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
20445 Bangor Rd
Crocker, MO 65452-8239
Mailing address
20445 Bangor Rd
Crocker, MO 65452-8239
Phone (573) 528-4153
Other providers in Crocker, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. 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.