Provider Demographics
NPI:1659493252
Name:KB MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:KB MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-877-1939
Mailing Address - Street 1:1501 N STOP 18 ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9609
Mailing Address - Country:US
Mailing Address - Phone:812-877-1939
Mailing Address - Fax:812-877-9620
Practice Address - Street 1:1501 N STOP 18 ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9609
Practice Address - Country:US
Practice Address - Phone:812-877-1939
Practice Address - Fax:812-877-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies