MEDICARE: KIMCO HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	24062	TX

General Provider Information

NPI Number	:	1073620399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMCO HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	211 FM 1960 RD W STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3536
Country	:	US
Telephone Number	:	281-583-2220
Fax Number	:	281-583-2236

Provider Business Practice Location Address
First Line	:	211 FM 1960 RD W STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3536
Country	:	US
Telephone Number	:	281-583-2220
Fax Number	:	281-583-2236

Authorized Official
Title or Position	:	CORP PRES
Name	:	KIMBERLY R HOWARD
Credential	:	RN
Telephone Number	:	713-682-6565

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/22/2020

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