MEDICARE: KND DEVELOPMENT 59 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	208M00000X	Hospitalist Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB109364	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1356670855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KND DEVELOPMENT 59 LLC

Provider Business Mailing Address
First Line	:	680 S 4TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-2407
Country	:	US
Telephone Number	:	502-596-7358
Fax Number	:	833-501-9731

Provider Business Practice Location Address
First Line	:	7800 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4203
Country	:	US
Telephone Number	:	817-346-0094
Fax Number	:	502-596-4150

Authorized Official
Title or Position	:	DVP REVENUE CYCLE
Name	:	LINDA L FISHER
Credential	:
Telephone Number	:	502-596-7358

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	06/17/2020

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