Healthcare Provider Details

I. General information

NPI: 1427443639
Provider Name (Legal Business Name): KILGORE RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 AMERICAN AVE SUITE F
JEFFERSON CITY MO
65109-1080
US

IV. Provider business mailing address

3103 W BROADWAY SUITE 115
COLUMBIA MO
65203-0497
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-5011
  • Fax: 573-636-5012
Mailing address:
  • Phone: 573-442-8338
  • Fax: 573-446-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number332BX200X
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B0000X
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. FRED BIETSCH III
Title or Position: VICE PRESIDENT
Credential:
Phone: 573-424-4652