MEDICARE: KNW MEDICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251F00000X	Home Infusion Agency
3	261QI0500X	Infusion Therapy Clinic/Center
4	261QP2300X	Primary Care Clinic/Center
5	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1720616014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNW MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	2151 SW BARTHEL ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4301
Country	:	US
Telephone Number	:	772-785-9419
Fax Number	:	772-785-9419

Provider Business Practice Location Address
First Line	:	2151 SW BARTHEL ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4301
Country	:	US
Telephone Number	:	772-785-9419
Fax Number	:	772-785-9419

Authorized Official
Title or Position	:	APRN
Name	:	KATHERINE N WILLINGHAM
Credential	:	APRN
Telephone Number	:	772-785-9419

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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