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General NPI Number Information
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NPI Number | 1619579794
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Entity Type | Organization
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Legal Business Name | KS IOM LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 918 E LAKECREST DR
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City | ANDOVER
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State | KS
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Zip | 67002-9343
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Country | US
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Telephone | 918-895-7680
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Fax | 918-236-4646
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Provider Business Mailing Address
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Address Line | PO BOX 720762
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City | NORMAN
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State | OK
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Zip | 73070-4590
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Country | US
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Telephone | 918-895-7680
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | VALERIE SHEHAN
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Credential |
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Telephone | 918-895-7680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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