Provider Demographics
NPI:1003192691
Name:KMA CERTIFIED TESTING, INC.
Entity Type:Organization
Organization Name:KMA CERTIFIED TESTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-213-7668
Mailing Address - Street 1:56 S 65TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2945
Mailing Address - Country:US
Mailing Address - Phone:618-213-7668
Mailing Address - Fax:618-213-7669
Practice Address - Street 1:56 S 65TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2945
Practice Address - Country:US
Practice Address - Phone:618-213-7668
Practice Address - Fax:618-213-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041192768261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service