Provider Demographics
NPI:1609015379
Name:KIMLOR MEDICAL SUPPLY
Entity Type:Organization
Organization Name:KIMLOR MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJARNATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-872-1885
Mailing Address - Street 1:PO BOX 7510
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-7510
Mailing Address - Country:US
Mailing Address - Phone:479-872-1885
Mailing Address - Fax:479-872-1889
Practice Address - Street 1:830 E ROBINSON AVE
Practice Address - Street 2:STE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7113
Practice Address - Country:US
Practice Address - Phone:479-872-1885
Practice Address - Fax:479-872-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies