MEDICARE: KOWASIC ENTERPRISES INCORPORATED

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1891802583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOWASIC ENTERPRISES INCORPORATED

Provider Business Mailing Address
First Line	:	1461 N DYSART RD
Second Line	:	SUITE 103
City	:	AVONDALE
State	:	AZ
Zip	:	85323-1538
Country	:	US
Telephone Number	:	623-932-5505
Fax Number	:	623-925-0752

Provider Business Practice Location Address
First Line	:	1461 N DYSART RD
Second Line	:	SUITE 103
City	:	AVONDALE
State	:	AZ
Zip	:	85323-1538
Country	:	US
Telephone Number	:	623-932-5505
Fax Number	:	623-925-0752

Authorized Official
Title or Position	:	VICE PRESIDENT/SECRETARY/SALES
Name	:	MRS. TRACY LYNN KOWASIC
Credential	:
Telephone Number	:	623-932-5505

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/22/2020

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