Provider Demographics
NPI:1942480942
Name:AMERICAN FREEDOM MEDICAL LLC
Entity Type:Organization
Organization Name:AMERICAN FREEDOM MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-691-8957
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-691-8957
Mailing Address - Fax:270-691-8959
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 312
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-691-8957
Practice Address - Fax:270-691-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6047180001Medicare NSC