Provider Demographics
NPI:1619579794
Name:KS IOM LLC
Entity Type:Organization
Organization Name:KS IOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-895-7680
Mailing Address - Street 1:PO BOX 720762
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4590
Mailing Address - Country:US
Mailing Address - Phone:918-895-7680
Mailing Address - Fax:
Practice Address - Street 1:918 E LAKECREST DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9343
Practice Address - Country:US
Practice Address - Phone:918-895-7680
Practice Address - Fax:918-236-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11171975OtherBIRTH DATE