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General NPI Number Information
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NPI Number | 1982890653
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Entity Type | Organization
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Legal Business Name | KC HEALTHCARE SUPPLIES LLC
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 5425 SUGARLOAF PKWY SUITE#1100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5764
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Country | US
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Telephone | 678-377-9660
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Fax | 678-377-9566
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Provider Business Mailing Address
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Address Line | 5425 SUGARLOAF PKWY SUITE #1100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5764
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Country | US
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Telephone | 678-377-9660
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Fax | 678-377-9566
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Authorized Official
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Title or Position | CEO
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Name | MRS. CHINWE O'KOLI
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Credential |
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Telephone | 678-377-9660
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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 | 07072500
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License Number State | GA
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