=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487169991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KS MEDICAL SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 04/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19455 GULF BLVD STE 8
-----------------------------------------------------
City | INDIAN SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33785-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-509-3050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19455 GULF BLVD STE 8
-----------------------------------------------------
City | INDIAN SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33785-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-509-3050
-----------------------------------------------------
Fax | 727-509-3051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY WOLFE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-560-2353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 7663930001
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------