Provider Demographics
NPI:1467483669
Name:KINNEY HOMECARE EQUIPMENT AND SUPPLIES, INC.
Entity Type:Organization
Organization Name:KINNEY HOMECARE EQUIPMENT AND SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE CONTRACTING & PAYOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-413-7800
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:21087 NYS RT 12F
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0027
Mailing Address - Country:US
Mailing Address - Phone:315-788-8280
Mailing Address - Fax:315-785-9715
Practice Address - Street 1:206 TOM MILLER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6427
Practice Address - Country:US
Practice Address - Phone:518-566-6445
Practice Address - Fax:518-566-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02918087Medicaid
NY01039541Medicaid