MEDICARE: KANMO INFUSION AND PATIENT TEACHING, LLC

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	163WI0500X	Infusion Therapy Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A-070-004	OTHER	KS	HOME HEALTH AGENCY LICENSE

General Provider Information

NPI Number	:	1184231243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANMO INFUSION AND PATIENT TEACHING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	GARDNER
State	:	KS
Zip	:	66030-0056
Country	:	US
Telephone Number	:	913-709-7731
Fax Number	:	913-956-0026

Provider Business Practice Location Address
First Line	:	30937 S INDIAN HILLS RD
Second Line	:
City	:	OSAGE CITY
State	:	KS
Zip	:	66523-9089
Country	:	US
Telephone Number	:	913-709-7731
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JANE COLLINS RAFTER
Credential	:	BSN, RN
Telephone Number	:	913-709-7731

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	10/12/2020

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