Organization
KC MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEENA RENNE SHELTON (CHIEF EXECUTIVE OFFICER)
(903) 234-0700
Entity
Organization
Contact information
Practice address
1605 JUDSON RD, SUITE D, LONGVIEW, TX 75601-3662
(903) 234-0700
(903) 234-0701
Mailing address
1605 JUDSON RD, SUITE D, LONGVIEW, TX 75601-3662
(903) 234-0700
(903) 234-0701
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0068887
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162672301
—
TX
01
—
162672302
MEDICAID
TX
05
—
1647179
—
LA
Enumeration date
08/30/2006
Last updated
07/03/2008
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