=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265446009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KASS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2817 STARK ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76112-6562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-451-9413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 STARK ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76112-6562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-451-9413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SYSTEM ADMINISTRATOR
-----------------------------------------------------
Name | MR. BENNY MAYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-457-8324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------