Healthcare Provider Details

I. General information

NPI: 1104765940
Provider Name (Legal Business Name): JKM DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 NE 91ST ST
KANSAS CITY MO
64155-3374
US

IV. Provider business mailing address

2 W 18TH ST
FORT SCOTT KS
66701-3177
US

V. Phone/Fax

Practice location:
  • Phone: 913-521-2333
  • Fax: 913-521-2336
Mailing address:
  • Phone: 620-223-4141
  • Fax:

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: KIMBERLY K PHILLIPS
Title or Position: MANAGER
Credential:
Phone: 620-223-4141