Healthcare Provider Details

I. General information

NPI: 1356390363
Provider Name (Legal Business Name): FAMILY MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 E 61ST ST N
PARK CITY KS
67219-1953
US

IV. Provider business mailing address

1542 E 61ST ST N
PARK CITY KS
67219-1953
US

V. Phone/Fax

Practice location:
  • Phone: 316-744-1261
  • Fax: 316-744-3443
Mailing address:
  • Phone: 316-744-1261
  • Fax: 316-744-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LISA RENE SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 316-744-1261