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Contact Information

NUTRITIONAL SUPPORT SERVICES
1329 HORAN DR
FENTON, MO63026-1939
 Phone: 636-779-2700
 Fax: 636-779-2704
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for NUTRITIONAL SUPPORT SERVICES

NPI # 1679594626
LBN Legal business name NUTRITIONAL SUPPORT SERVICES
Authorized official TERRY LEEMAN - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/22/2006
Last updated 01/28/2020 - About 6 years ago
Identifiers
MO License # 2004034239
MO Medicaid 606172203
Other 2049057 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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