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General NPI Number Information
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NPI Number | 1144333089
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Entity Type | Organization
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Legal Business Name | KINGDOM MEDICAL EQUIPMENT LLC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1824 NW 52ND ST
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City | LAWTON
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State | OK
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Zip | 73505-3122
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Country | US
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Telephone | 580-355-1511
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Fax | 580-355-0455
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Provider Business Mailing Address
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Address Line | 1834 NW 52ND ST
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City | LAWTON
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State | OK
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Zip | 73505-3122
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Country | US
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Telephone | 580-355-1511
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Fax | 580-355-0455
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAY HILLIARD
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Credential |
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Telephone | 580-355-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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