Healthcare Provider Details

I. General information

NPI: 1932523974
Provider Name (Legal Business Name): KSM CORPORATE HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 W LAKE MEAD BLVD SUITE 3
LAS VEGAS NV
89134-8338
US

IV. Provider business mailing address

9430 W LAKE MEAD BLVD SUITE 3
LAS VEGAS NV
89134-8338
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-2118
  • Fax:
Mailing address:
  • Phone: 702-998-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberNV20121603160
License Number StateNV

VIII. Authorized Official

Name: KEVIN M MCMANUS
Title or Position: OWNER
Credential:
Phone: 702-998-2118