Provider Demographics
NPI:1073602256
Name:BRUNER TAMMY
Entity Type:Organization
Organization Name:BRUNER TAMMY
Other - Org Name:KEM KARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:574-269-3306
Mailing Address - Street 1:30 EMS C30 LANE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582
Mailing Address - Country:US
Mailing Address - Phone:574-269-3306
Mailing Address - Fax:
Practice Address - Street 1:119 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952
Practice Address - Country:US
Practice Address - Phone:765-664-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28060524A335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097375OtherBLUE CROSS BLUE SHIELD
IN100124200AMedicaid
IN0272750001Medicare ID - Type Unspecified