Active NPI
Tim Mitchell Medical, Inc
- Durable Medical Equipment & Medical Supplies
- Neosho, MO
National Provider Identifier
1902945470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- TIM MITCHELL MEDICAL, INC
- Doing business as
- Country Care Pharmacy
Mitchell's Uptown Drug Store - Practice address
- 1504 N Business 49
Neosho, MO 64850-6883 - Phone
- (417) 451-9301
- Fax
- (417) 451-9307
- NPI assigned
- Feb 5, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael C Smith, R.PH.
- Title
- Manager
- Phone
- (417) 451-9301
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
1504 N Business 49
Neosho, MO 64850-6883
Mailing address
1009 S Neosho Blvd
Neosho, MO 64850-2008
Phone (417) 455-1883
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 606120509 | Medicaid | MO | |
| 626120505 | Medicaid | MO |
Other names 2
- Country Care Pharmacy
- Mitchell's Uptown Drug Store
National Provider Directory
National Provider DirectoryLocations
1504 N Business 49
Neosho, MO 64850
Phone (417) 451-9301
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1588032000000",
"number": "1902945470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1009 S NEOSHO BLVD",
"city": "NEOSHO",
"state": "MO",
"postal_code": "648502008",
"telephone_number": "417-455-1883",
"fax_number": "417-455-1889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 N BUSINESS 49",
"city": "NEOSHO",
"state": "MO",
"postal_code": "648506883",
"telephone_number": "417-451-9301",
"fax_number": "417-451-9307"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TIM MITCHELL MEDICAL, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-05",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "417-451-9301",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "R.PH."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "606120509",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "626120505",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Country Care Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mitchell's Uptown Drug Store",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Neosho, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.