=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174105316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KM SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2021
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 MILL RIDGE RD STE 112
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-524-3420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 MILL RIDGE RD STE 112
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-524-3420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MR. KENNETH SHAE MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-784-7197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------