Healthcare Provider Details

I. General information

NPI: 1427503408
Provider Name (Legal Business Name): KME ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 4TH ST STE 550
SAINT LOUIS MO
63102-1897
US

IV. Provider business mailing address

100 S 4TH ST
SAINT LOUIS MO
63102-1800
US

V. Phone/Fax

Practice location:
  • Phone: 404-860-9547
  • Fax:
Mailing address:
  • Phone: 404-860-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: KATHY M EVANS
Title or Position: CEO
Credential:
Phone: 404-860-9547