Provider Demographics
NPI:1184231243
Name:KANMO INFUSION AND PATIENT TEACHING, LLC
Entity Type:Organization
Organization Name:KANMO INFUSION AND PATIENT TEACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:RAFTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:913-709-7731
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-0056
Mailing Address - Country:US
Mailing Address - Phone:913-709-7731
Mailing Address - Fax:913-956-0026
Practice Address - Street 1:30937 S INDIAN HILLS RD
Practice Address - Street 2:
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-9089
Practice Address - Country:US
Practice Address - Phone:913-709-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-070-004OtherHOME HEALTH AGENCY LICENSE