Provider Demographics
NPI:1588414965
Name:KYNETIC MEDICAL GROUP INC
Entity type:Organization
Organization Name:KYNETIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-250-8511
Mailing Address - Street 1:1516 E TROPICANA AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8323
Mailing Address - Country:US
Mailing Address - Phone:725-250-8511
Mailing Address - Fax:702-552-5042
Practice Address - Street 1:1516 E TROPICANA AVE STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8323
Practice Address - Country:US
Practice Address - Phone:725-250-8511
Practice Address - Fax:702-552-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies