Provider Demographics
NPI:1811389158
Name:KO PEST CONTROL
Entity Type:Organization
Organization Name:KO PEST CONTROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-402-1078
Mailing Address - Street 1:3575 HIGHWAY 138
Mailing Address - Street 2:
Mailing Address - City:TOONE
Mailing Address - State:TN
Mailing Address - Zip Code:38381-8077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3575 HWY 138
Practice Address - Street 2:
Practice Address - City:TOONE
Practice Address - State:TN
Practice Address - Zip Code:38381
Practice Address - Country:US
Practice Address - Phone:731-402-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170354228320700000X
TN78989323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========Other=========