Provider Demographics
NPI:1730186735
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:MR
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 ROAD
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:888-845-3342
Practice Address - Street 1:601 AUTUMN RD # 204
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3605
Practice Address - Country:US
Practice Address - Phone:800-845-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0697140001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
AR0697140001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER