MEDICARE: KILGORE RESPIRATORY SERVICES 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477741114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KILGORE RESPIRATORY SERVICES INC

Provider Business Mailing Address
First Line	:	1815 CHAPEL HILL RD STE 210
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5420
Country	:	US
Telephone Number	:	573-442-8338
Fax Number	:	573-446-5008

Provider Business Practice Location Address
First Line	:	1815 CHAPEL HILL RD STE 210
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5420
Country	:	US
Telephone Number	:	573-442-8338
Fax Number	:	573-446-5008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KELLY ANN BIETSCH
Credential	:	RRT
Telephone Number	:	573-424-0202

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	08/13/2019

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