Provider Demographics
NPI:1366505752
Name:KINGSWAY MEDICAL SYSTEMS, INC
Entity Type:Organization
Organization Name:KINGSWAY MEDICAL SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOEMENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-228-8111
Mailing Address - Street 1:331 MELROSE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4405
Mailing Address - Country:US
Mailing Address - Phone:972-228-8111
Mailing Address - Fax:972-228-8332
Practice Address - Street 1:331 MELROSE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4405
Practice Address - Country:US
Practice Address - Phone:972-228-8111
Practice Address - Fax:972-228-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5415750001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5415750001OtherDME SUPPLIER