Healthcare Provider Details

I. General information

NPI: 1013943372
Provider Name (Legal Business Name): KANOME SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 W LAFAYETTE ST
WINNFIELD LA
71483-3451
US

IV. Provider business mailing address

25 KANOME ROAD
LECOMPTE LA
71346-9999
US

V. Phone/Fax

Practice location:
  • Phone: 318-648-2220
  • Fax: 318-648-2270
Mailing address:
  • Phone: 318-730-5640
  • Fax: 413-653-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number16604
License Number StateLA

VIII. Authorized Official

Name: MR. HOWARD W. JACKSON JR.
Title or Position: OWNER
Credential: R,D.C.S.
Phone: 318-730-5640