Provider Demographics
NPI:1215121629
Name:RANDALL KUNZE DPM LLC
Entity type:Organization
Organization Name:RANDALL KUNZE DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:417-358-8566
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0424
Mailing Address - Country:US
Mailing Address - Phone:417-358-8566
Mailing Address - Fax:417-358-2428
Practice Address - Street 1:1503 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2829
Practice Address - Country:US
Practice Address - Phone:417-358-8566
Practice Address - Fax:417-358-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000634332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506137108Medicaid
NEP00350052OtherMC RAILROAD
MO9912OtherBCBS MO
MO302951702Medicaid
MO139389OtherHEALTHLINK
DF2473OtherMC RAILROAD GROUP
MO4503370001Medicare NSC
MOU05430Medicare UPIN
NEP00350052OtherMC RAILROAD
MO213035100Medicare Oscar/Certification