1619061686 NPI number — K-A MEDICAL SERVICES INC

Table of content: (NPI 1619061686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619061686 NPI number — K-A MEDICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K-A MEDICAL SERVICES INC
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:
Provider Other Organization Name Type Code:
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:
1619061686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOLLINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25646-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-752-2115
Provider Business Mailing Address Fax Number:
304-752-5934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT 44
Provider Second Line Business Practice Location Address:
SOUTH WILKINSON
Provider Business Practice Location Address City Name:
WILKINSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-2115
Provider Business Practice Location Address Fax Number:
304-752-5934
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRADDOCK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
304-752-2115

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 040567600 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1461381 . This is a "UMWA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 6099002000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001705507 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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