Healthcare Provider Details

I. General information

NPI: 1275836819
Provider Name (Legal Business Name): KANSAS MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S KANSAS AVE
COLUMBUS KS
66725
US

IV. Provider business mailing address

217 SOUTH KANSAS AVE
COLUMBUS KS
66725
US

V. Phone/Fax

Practice location:
  • Phone: 620-429-1999
  • Fax: 620-429-1980
Mailing address:
  • Phone: 620-429-1999
  • Fax: 620-429-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number16-00454
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number16-00454
License Number StateKS

VIII. Authorized Official

Name: JASON W, HULVEY
Title or Position: OWNER/PRESIDENT
Credential: PHARM.D.
Phone: 620-429-1999