Provider Demographics
NPI:1477206506
Name:KMD EDUCATIONAL INSTITUTE
Entity Type:Organization
Organization Name:KMD EDUCATIONAL INSTITUTE
Other - Org Name:KMDEI,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEYSHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-222-4220
Mailing Address - Street 1:1530 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9585
Mailing Address - Country:US
Mailing Address - Phone:980-222-4220
Mailing Address - Fax:
Practice Address - Street 1:1530 LEGION DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9585
Practice Address - Country:US
Practice Address - Phone:980-222-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No253Z00000XAgenciesIn Home Supportive Care