=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003597394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KITSWNE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2023
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2738 CALKINS RD
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20171-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-401-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2738 CALKINS RD
-----------------------------------------------------
City | HERNDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20171-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-401-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | TERRY JOOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-401-0361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------