Provider Demographics
NPI:1033735360
Name:KISX CARD LLC
Entity Type:Organization
Organization Name:KISX CARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-574-1798
Mailing Address - Street 1:1 KACEY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-9223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 KACEY CT STE 100
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-9223
Practice Address - Country:US
Practice Address - Phone:717-790-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KISX CARD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management