Provider Demographics
NPI:1346274230
Name:KCS MEDICAL HOME CARE SUPPLIES INC
Entity Type:Organization
Organization Name:KCS MEDICAL HOME CARE SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-716-7678
Mailing Address - Street 1:100 ETOWAH TRACE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-716-7678
Mailing Address - Fax:770-716-1814
Practice Address - Street 1:100 ETOWAH TRACE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-716-7678
Practice Address - Fax:770-716-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
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
GA0421430001Medicare ID - Type Unspecified