Healthcare Provider Details

I. General information

NPI: 1093020984
Provider Name (Legal Business Name): KENNETH BEMIS CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEB BEMIS

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 TIGER LILY WAY
HIGHLANDS RANCH CO
80126-5710
US

IV. Provider business mailing address

13259 PINETREE LAKE DR
CHESTERFIELD MO
63017-5923
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-8001
  • Fax:
Mailing address:
  • Phone: 503-740-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: