Provider Demographics
NPI:1487829313
Name:K/S-MST, INC.
Entity Type:Organization
Organization Name:K/S-MST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUNZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-927-0020
Mailing Address - Street 1:1352 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-1852
Mailing Address - Country:US
Mailing Address - Phone:267-927-0020
Mailing Address - Fax:215-343-7030
Practice Address - Street 1:1352 EASTON RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1852
Practice Address - Country:US
Practice Address - Phone:267-927-0020
Practice Address - Fax:215-343-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003215L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019418500002Medicaid