Healthcare Provider Details

I. General information

NPI: 1013453117
Provider Name (Legal Business Name): KYMCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7074 E 5TH AVE
SCOTTSDALE AZ
85251-3216
US

IV. Provider business mailing address

7074 E. FIFTH AVE
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 480-329-3778
  • Fax:
Mailing address:
  • Phone: 480-329-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY WATERS
Title or Position: OWNER
Credential:
Phone: 480-429-3778