Provider Demographics
NPI:1124336532
Name:KIGHT'S MEDICAL CORP
Entity type:Organization
Organization Name:KIGHT'S MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-878-6666
Mailing Address - Street 1:201 KITTY HAWK DR
Mailing Address - Street 2:STE 95
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7659
Mailing Address - Country:US
Mailing Address - Phone:919-878-6666
Mailing Address - Fax:919-878-4411
Practice Address - Street 1:901 PORT CENTRE PKWY
Practice Address - Street 2:SUITE 8
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-6761
Practice Address - Country:US
Practice Address - Phone:757-392-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA37948332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705039Medicaid
VA1033372248Medicaid
NC0709670005Medicare NSC
NC0709670001Medicare NSC
VA0709670009Medicare NSC