Healthcare Provider Details

I. General information

NPI: 1477974772
Provider Name (Legal Business Name): K & L CONTRACTING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E 2ND ST
SPRINGFIELD OH
45504-1449
US

IV. Provider business mailing address

134 E 2ND ST
SPRINGFIELD OH
45504-1449
US

V. Phone/Fax

Practice location:
  • Phone: 937-631-5799
  • Fax:
Mailing address:
  • Phone: 937-631-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0083706
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerOHIO DEPARTMENT OF JOBS AND FAMILY SERVICES

VIII. Authorized Official

Name: KURTLAND C FANCETT
Title or Position: PRESIDENT
Credential:
Phone: 937-631-5799