Provider Demographics
NPI:1538301080
Name:KINGSGATE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:KINGSGATE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-275-1950
Mailing Address - Street 1:1117 W PIONEER PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6395
Mailing Address - Country:US
Mailing Address - Phone:817-275-1950
Mailing Address - Fax:817-275-1895
Practice Address - Street 1:1117 W PIONEER PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6395
Practice Address - Country:US
Practice Address - Phone:817-275-1950
Practice Address - Fax:817-275-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000013332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies