Provider Demographics
NPI:1235343666
Name:KOER MEDICAL
Entity Type:Organization
Organization Name:KOER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERCK
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-518-0391
Mailing Address - Street 1:2250 N ROCK RD
Mailing Address - Street 2:#118-243
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 N ROCK RD
Practice Address - Street 2:#118-243
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2325
Practice Address - Country:US
Practice Address - Phone:316-650-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48403OtherBCBS
KS48403OtherBCBS