1023207560 NPI number — KSF LLC

Table of content: (NPI 1023207560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023207560 NPI number — KSF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KSF LLC
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:
6
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:
1023207560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 W MEETING ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29720-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-285-7948
Provider Business Mailing Address Fax Number:
803-283-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 W MEETING ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29720-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-285-7948
Provider Business Practice Location Address Fax Number:
803-283-4329
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEALY
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
803-825-7948

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0716208 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6028500001 . This is a "MEDICARE DME (PTAN)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DE3106 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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