MEDICARE: K & M MEDICAL SUPPLY, 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

General Provider Information

NPI Number	:	1801125240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K & M MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2440 TEXAS PARKWAY
Second Line	:	#330
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489
Country	:	US
Telephone Number	:	713-822-2945
Fax Number	:	281-403-9658

Provider Business Practice Location Address
First Line	:	11901 SHADOW CREEK PKWY
Second Line	:	SUITE 103
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	713-822-2945
Fax Number	:	281-741-0954

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MATTIE MAE TYO
Credential	:
Telephone Number	:	713-822-2945

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	11/15/2011

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