Healthcare Provider Details

I. General information

NPI: 1861878613
Provider Name (Legal Business Name): KILGORE RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E SUMMIT ST SUITE A
MEXICO MO
65265-3298
US

IV. Provider business mailing address

1815 CHAPEL HILL RD STE 210
COLUMBIA MO
65203-5420
US

V. Phone/Fax

Practice location:
  • Phone: 573-567-7999
  • Fax: 573-567-7045
Mailing address:
  • Phone: 573-442-8338
  • Fax: 573-446-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FRED BIETSCH
Title or Position: VICE PRESIDENT
Credential:
Phone: 573-442-8338