Provider Demographics
NPI:1669539979
Name:KNEVITT INC
Entity type:Organization
Organization Name:KNEVITT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1618-548-0001
Mailing Address - Street 1:3340 SELMAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-548-0001
Mailing Address - Fax:618-548-0003
Practice Address - Street 1:3340 SELMAVILLE RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-0001
Practice Address - Fax:618-548-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5 52343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006132012OtherBLUECROSS BLUESHIELD OF I
IL0006132012OtherBLUECROSS BLUESHIELD OF I
IL========= 0002OtherCIGNA HEALTHCARE
IL=========-00OtherAFLAC
IL=========OtherPYRAMID
IL=========001Medicaid
IL=========OtherGLOBE LIFE
IL=========OtherTHE MUTUAL OF OMAHA
IL=========OtherUNICARE
IL=========OtherUNICARE
IL========= 0002OtherCIGNA HEALTHCARE