MEDICARE: KENNEY ORTHOPEDICS OF MONROE, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1326385949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEY ORTHOPEDICS OF MONROE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 ELLEN ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-5173
Country	:	US
Telephone Number	:	704-635-7029
Fax Number	:	704-635-7495

Authorized Official
Title or Position	:	PROVIDER CONTRACT ANALYST III
Name	:	GRACE ANGELINE
Credential	:
Telephone Number	:	714-961-2102

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	03/05/2024

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