Provider Demographics
NPI:1780013706
Name:KYBRA PRODUCTS, L.L.C.
Entity Type:Organization
Organization Name:KYBRA PRODUCTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-760-1850
Mailing Address - Street 1:3070 BRISTOL PIKE STE 2-120
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5357
Mailing Address - Country:US
Mailing Address - Phone:215-600-1310
Mailing Address - Fax:267-463-4849
Practice Address - Street 1:3070 BRISTOL PIKE STE 2-120
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5357
Practice Address - Country:US
Practice Address - Phone:215-600-1310
Practice Address - Fax:267-463-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000008234332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7096950001OtherMEDICARE PTAN