MEDICARE: KINGSMOUNT 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	:	1902139504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSMOUNT INC

Provider Business Mailing Address
First Line	:	9808 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2190
Country	:	US
Telephone Number	:	215-676-7463
Fax Number	:	215-676-1110

Provider Business Practice Location Address
First Line	:	2917 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2802
Country	:	US
Telephone Number	:	215-739-7463
Fax Number	:	215-739-7463

Authorized Official
Title or Position	:	MANAGER
Name	:	SOFYA TAMARKIN
Credential	:	C. PED,, MBA
Telephone Number	:	21530033355

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/17/2014

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Directions to “KINGSMOUNT INC ” Practice Location

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