Provider Demographics
NPI:1033203146
Name:K2RED L.L.C.
Entity Type:Organization
Organization Name:K2RED L.L.C.
Other - Org Name:HOME IV SERVICES & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-735-8700
Mailing Address - Street 1:526 SHOUP AVE W STE L
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5050
Mailing Address - Country:US
Mailing Address - Phone:208-735-8700
Mailing Address - Fax:208-734-7389
Practice Address - Street 1:526 SHOUP AVE W STE L
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-735-8700
Practice Address - Fax:208-734-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1333LS332BP3500X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805182700Medicaid
ID805156800Medicaid
ID0788360003Medicare NSC