Provider Demographics
NPI:1699761999
Name:KELMEDIX INC
Entity type:Organization
Organization Name:KELMEDIX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWANSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-592-1063
Mailing Address - Street 1:4646 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-592-1063
Mailing Address - Fax:352-592-1064
Practice Address - Street 1:4646 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-592-1063
Practice Address - Fax:352-592-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3700016853797332B00000X
332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021955000Medicaid
FLR9018OtherBCBS