Provider Demographics
NPI:1669247011
Name:KIMBERLY MARIE LLC
Entity type:Organization
Organization Name:KIMBERLY MARIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-882-8000
Mailing Address - Street 1:3 W JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IL
Mailing Address - Zip Code:62275-1032
Mailing Address - Country:US
Mailing Address - Phone:618-882-8000
Mailing Address - Fax:
Practice Address - Street 1:3 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IL
Practice Address - Zip Code:62275-1032
Practice Address - Country:US
Practice Address - Phone:618-882-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty