Provider Demographics
NPI:1205317195
Name:KEN GLOVER MEDICAL SPECIALTY, INC.
Entity type:Organization
Organization Name:KEN GLOVER MEDICAL SPECIALTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:205-648-9918
Mailing Address - Street 1:100 HULL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-4317
Mailing Address - Country:US
Mailing Address - Phone:205-255-6479
Mailing Address - Fax:205-648-9644
Practice Address - Street 1:100 HULL RD STE 101
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-4317
Practice Address - Country:US
Practice Address - Phone:205-255-6479
Practice Address - Fax:205-648-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies