Provider Demographics
NPI:1316955065
Name:KALEIDOSCOPE ENTERPRISES LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:806-359-4550
Mailing Address - Street 1:PO BOX 52108
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-2108
Mailing Address - Country:US
Mailing Address - Phone:806-367-5047
Mailing Address - Fax:
Practice Address - Street 1:6817 WOLFLIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2174
Practice Address - Country:US
Practice Address - Phone:806-367-5047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX532278OtherBCBS
TX182848502Medicaid
TX182848501Medicaid
TX532278OtherBCBS