Provider Demographics
NPI:1316145873
Name:KEVCON RESPIRATORY HOME CARE
Entity type:Organization
Organization Name:KEVCON RESPIRATORY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-866-3177
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-866-3177
Mailing Address - Fax:573-866-2353
Practice Address - Street 1:RT 2 BOX 2060
Practice Address - Street 2:
Practice Address - City:SEDGEWICKVILLE
Practice Address - State:MO
Practice Address - Zip Code:63781
Practice Address - Country:US
Practice Address - Phone:573-866-3177
Practice Address - Fax:573-866-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0183530001Medicare ID - Type Unspecified