Provider Demographics
NPI:1427443639
Name:KILGORE RESPIRATORY SERVICES INC
Entity type:Organization
Organization Name:KILGORE RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BIETSCH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:573-424-4652
Mailing Address - Street 1:3103 W BROADWAY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0497
Mailing Address - Country:US
Mailing Address - Phone:573-442-8338
Mailing Address - Fax:573-446-5008
Practice Address - Street 1:3349 AMERICAN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1080
Practice Address - Country:US
Practice Address - Phone:573-636-5011
Practice Address - Fax:573-636-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B0000X332B00000X
MO332BX200X332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6039410002Medicare NSC