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General NPI Number Information
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NPI Number | 1366505752
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Entity Type | Organization
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Legal Business Name | KINGSWAY MEDICAL SYSTEMS, INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 331 MELROSE DR SUITE 102
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City | RICHARDSON
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State | TX
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Zip | 75080-4405
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Country | US
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Telephone | 972-228-8111
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Fax | 972-228-8332
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Provider Business Mailing Address
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Address Line | 331 MELROSE DR SUITE 102
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City | RICHARDSON
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State | TX
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Zip | 75080-4405
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Country | US
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Telephone | 972-228-8111
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Fax | 972-228-8332
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PHILIP ODOEMENA
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Credential |
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Telephone | 972-228-8111
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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 | 5415750001
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License Number State | TX
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