Provider Demographics
NPI:1710233747
Name:KMR MEDICAL SUPPLY
Entity Type:Organization
Organization Name:KMR MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOKSTOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-692-1355
Mailing Address - Street 1:831 E 340 S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3327
Mailing Address - Country:US
Mailing Address - Phone:801-692-1354
Mailing Address - Fax:888-933-1363
Practice Address - Street 1:831 E 340 S
Practice Address - Street 2:SUITE 150
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3327
Practice Address - Country:US
Practice Address - Phone:801-692-1354
Practice Address - Fax:888-933-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies