Healthcare Provider Details

I. General information

NPI: 1457315418
Provider Name (Legal Business Name): KIGHT'S MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KITTY HAWK DR SUITE 95
MORRISVILLE NC
27560-7659
US

IV. Provider business mailing address

201 KITTY HAWK DR SUITE 95
MORRISVILLE NC
27560-7659
US

V. Phone/Fax

Practice location:
  • Phone: 919-878-6666
  • Fax: 919-878-4411
Mailing address:
  • Phone: 919-878-6666
  • Fax: 919-878-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0206009179
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00562
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number01023
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05612
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN A KIGHT
Title or Position: CEO AND PRESIDENT
Credential: RPH
Phone: 919-878-6666