MEDICARE: SK & PKW 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	342000000X	Transportation Network Company
3	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1790488567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SK & PKW LLC

Provider Business Mailing Address
First Line	:	2323 BENNETT AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-6112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 BENNETT AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-6112
Country	:	US
Telephone Number	:	515-344-3153
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	PETERSON WAMBUU
Credential	:
Telephone Number	:	515-344-3153

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	04/05/2023

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Directions to “SK & PKW LLC ” Practice Location

Language	Start Address	Practice Location

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