Provider Demographics
NPI:1801125240
Name:K & M MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:K & M MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:TYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-822-2945
Mailing Address - Street 1:2440 TEXAS PARKWAY
Mailing Address - Street 2:#330
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489
Mailing Address - Country:US
Mailing Address - Phone:713-822-2945
Mailing Address - Fax:281-403-9658
Practice Address - Street 1:11901 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7346
Practice Address - Country:US
Practice Address - Phone:713-822-2945
Practice Address - Fax:281-741-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6472120001Medicare NSC