MEDICARE: KENWAYS DISTRIBUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	253Z00000X	TX

General Provider Information

NPI Number	:	1669608311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENWAYS DISTRIBUTIONS, LLC

Provider Business Mailing Address
First Line	:	4640 HEDGCOXE RD
Second Line	:	APT 1521
City	:	PLANO
State	:	TX
Zip	:	75024-3885
Country	:	US
Telephone Number	:	972-704-5344
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 HEDGCOXE RD
Second Line	:	APT 1521
City	:	PLANO
State	:	TX
Zip	:	75024-3885
Country	:	US
Telephone Number	:	972-704-5344
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. PETER KIMUKUN BIWOT
Credential	:
Telephone Number	:	972-704-5344

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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