1235323643 NPI number — KILMICHAEL MEDICAL SUPPLIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235323643 NPI number — KILMICHAEL MEDICAL SUPPLIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KILMICHAEL MEDICAL SUPPLIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INHEALTH MEDICAL SUPPLIES LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235323643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILMICHAEL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-283-1551
Provider Business Mailing Address Fax Number:
662-283-2332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 N FRONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-283-1551
Provider Business Practice Location Address Fax Number:
662-283-2332
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
662-283-1551

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00440411 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00330316 . This is a "MCD PHARMACY" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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