Provider Demographics
NPI:1891813911
Name:K M PROVIDER SERVICES INC.
Entity type:Organization
Organization Name:K M PROVIDER SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHEREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NWAKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-419-6084
Mailing Address - Street 1:1201 N WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6190
Mailing Address - Country:US
Mailing Address - Phone:817-419-6084
Mailing Address - Fax:817-419-6084
Practice Address - Street 1:1201 N WATSON RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6190
Practice Address - Country:US
Practice Address - Phone:817-419-6084
Practice Address - Fax:817-419-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011105OtherSTATE LICENSE
TX743193Medicare Oscar/Certification