Provider Demographics
NPI:1508823188
Name:KAREN AMMON
Entity Type:Organization
Organization Name:KAREN AMMON
Other - Org Name:SENIOR MOBILITY AND MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-298-0046
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0480
Mailing Address - Country:US
Mailing Address - Phone:270-298-0046
Mailing Address - Fax:270-298-0079
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1123
Practice Address - Country:US
Practice Address - Phone:270-298-0046
Practice Address - Fax:270-298-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012022Medicaid
KY50017879OtherPASSPORT HEALTH PLAN
000000475146OtherANTHEM
KY90012022Medicaid