=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154530202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KND MEDICAL SUPPLIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11631 NEBEL ST
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-816-9100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10925
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20914-0925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-816-9100
-----------------------------------------------------
Fax | 301-816-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IMAOBONG AKPAETE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-816-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 15255493
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------