Provider Demographics
NPI:1235811951
Name:KEMET HEALTH ONE LLC
Entity type:Organization
Organization Name:KEMET HEALTH ONE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-256-1600
Mailing Address - Street 1:169 MADISON AVE # 11841
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5101
Mailing Address - Country:US
Mailing Address - Phone:703-256-1600
Mailing Address - Fax:
Practice Address - Street 1:317 E CAPITOL ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-3405
Practice Address - Country:US
Practice Address - Phone:703-256-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEMET HEALTH ONE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-02
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health