Provider Demographics
NPI:1255770129
Name:KINEX MEDICAL COMPANY, LLC.
Entity type:Organization
Organization Name:KINEX MEDICAL COMPANY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCKHOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-845-6364
Mailing Address - Street 1:1801 AIRPORT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2477
Mailing Address - Country:US
Mailing Address - Phone:800-845-6364
Mailing Address - Fax:
Practice Address - Street 1:5959 SHALLOWFORD RD STE 521
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2236
Practice Address - Country:US
Practice Address - Phone:800-845-6364
Practice Address - Fax:888-845-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7139150001Medicare NSC