MEDICARE: JB KUMMER ENTERPRISES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609453323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JB KUMMER ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	916 8TH ST
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-1438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 8TH ST
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-1438
Country	:	US
Telephone Number	:	651-460-4201
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAIME KUMMER
Credential	:
Telephone Number	:	651-460-4201

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	03/27/2021

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