Provider Demographics
NPI:1942884960
Name:BKT COLLECTION & EXTENSIONS LLC
Entity Type:Organization
Organization Name:BKT COLLECTION & EXTENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:601-549-0710
Mailing Address - Street 1:490 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8030
Mailing Address - Country:US
Mailing Address - Phone:601-549-0710
Mailing Address - Fax:601-549-0710
Practice Address - Street 1:929 GLITTER LN
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2036
Practice Address - Country:US
Practice Address - Phone:601-549-0710
Practice Address - Fax:601-549-0710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BKT COLLECTION & EXTENSIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-06
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier