Provider Demographics
NPI:1174567937
Name:K & W MEDICAL SERVICES INC
Entity type:Organization
Organization Name:K & W MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-272-1234
Mailing Address - Street 1:254 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5918
Mailing Address - Country:US
Mailing Address - Phone:717-272-1234
Mailing Address - Fax:717-270-2875
Practice Address - Street 1:254 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5918
Practice Address - Country:US
Practice Address - Phone:717-272-1234
Practice Address - Fax:717-270-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035966OtherGATEWAY HEALTH PLAN
PA248062OtherPA BLUE SHIELD HIGHMARK
PA590013358OtherPALMETTO RR MEDICARE
PA0017651150006Medicaid
PA0017651150006Medicaid