Provider Demographics
NPI:1477828804
Name:KMR MEDICAL LLC
Entity Type:Organization
Organization Name:KMR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-692-1056
Mailing Address - Street 1:831 E 340 S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3327
Mailing Address - Country:US
Mailing Address - Phone:801-692-1056
Mailing Address - Fax:866-503-0131
Practice Address - Street 1:831 E 340 S
Practice Address - Street 2:SUITE 130
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3327
Practice Address - Country:US
Practice Address - Phone:801-692-1056
Practice Address - Fax:866-503-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies