Provider Demographics
NPI:1023825163
Name:KAYCLARKEN & SHELBY LLC
Entity type:Organization
Organization Name:KAYCLARKEN & SHELBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-413-3435
Mailing Address - Street 1:838 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3164
Mailing Address - Country:US
Mailing Address - Phone:314-413-3435
Mailing Address - Fax:
Practice Address - Street 1:1133 E AIRLINE DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2283
Practice Address - Country:US
Practice Address - Phone:618-801-1633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies