Healthcare Provider Details

I. General information

NPI: 1245022474
Provider Name (Legal Business Name): KJK SERVICEAND SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 GUION RD STE G
INDIANAPOLIS IN
46268-3017
US

IV. Provider business mailing address

8770 GUION RD STE G
INDIANAPOLIS IN
46268-3017
US

V. Phone/Fax

Practice location:
  • Phone: 866-886-2009
  • Fax: 317-614-7988
Mailing address:
  • Phone: 866-886-2009
  • Fax: 317-614-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GRANT KLINEDINST
Title or Position: CEO
Credential: ATP
Phone: 866-886-2009