Provider Demographics
NPI:1710190400
Name:KSS DURABLE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:KSS DURABLE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-385-5040
Mailing Address - Street 1:5209 N JARDOT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-6128
Mailing Address - Country:US
Mailing Address - Phone:405-385-5040
Mailing Address - Fax:405-385-5009
Practice Address - Street 1:5209 N JARDOT
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-6128
Practice Address - Country:US
Practice Address - Phone:405-385-5040
Practice Address - Fax:405-385-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4200180002Medicare NSC