Provider Demographics
NPI:1154452241
Name:KINEX MEDICAL COMPANY, LLC
Entity Type:Organization
Organization Name:KINEX MEDICAL COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKHOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-845-6364
Mailing Address - Street 1:1801 AIRPORT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2477
Mailing Address - Country:US
Mailing Address - Phone:800-845-6364
Mailing Address - Fax:888-845-3342
Practice Address - Street 1:5985 HAUCK ST STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2811
Practice Address - Country:US
Practice Address - Phone:800-845-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINEX MEDICAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00623332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4360910001Medicare ID - Type Unspecified