1467483669 NPI number — KINNEY HOMECARE EQUIPMENT AND SUPPLIES, INC.

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 1467483669 NPI number — KINNEY HOMECARE EQUIPMENT AND SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINNEY HOMECARE EQUIPMENT AND SUPPLIES, 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:
1467483669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
21087 NYS RT 12F
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13601-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-788-8280
Provider Business Mailing Address Fax Number:
315-785-9715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
288 CORNELIA ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-566-6445
Provider Business Practice Location Address Fax Number:
518-566-9875
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
VP MANAGED CARE CONTRACTING & PAYOR
Authorized Official Telephone Number:
315-413-7800

Provider Taxonomy Codes

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

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

  • Identifier: 02918087 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".