MEDICARE: KC MEDICAL SUPPLIES

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	0068887	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962512087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	1605 JUDSON RD
Second Line	:	SUITE D
City	:	LONGVIEW
State	:	TX
Zip	:	75601-3662
Country	:	US
Telephone Number	:	903-234-0700
Fax Number	:	903-234-0701

Provider Business Practice Location Address
First Line	:	1605 JUDSON RD
Second Line	:	SUITE D
City	:	LONGVIEW
State	:	TX
Zip	:	75601-3662
Country	:	US
Telephone Number	:	903-234-0700
Fax Number	:	903-234-0701

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. SHEENA RENNE SHELTON
Credential	:
Telephone Number	:	903-234-0700

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/03/2008

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Directions to “KC MEDICAL SUPPLIES ” Practice Location

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