Provider Demographics
NPI:1164748778
Name:KC MEDICAL INC.
Entity Type:Organization
Organization Name:KC MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-372-5980
Mailing Address - Street 1:9455 LORTON MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1962
Mailing Address - Country:US
Mailing Address - Phone:703-372-5980
Mailing Address - Fax:703-372-5981
Practice Address - Street 1:9455 LORTON MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1962
Practice Address - Country:US
Practice Address - Phone:703-372-5980
Practice Address - Fax:703-372-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies