Provider Demographics
NPI:1447997150
Name:KGA MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:KGA MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MA GRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CADET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-412-6802
Mailing Address - Street 1:111 E MONUMENT AVE
Mailing Address - Street 2:STE 401-10
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5774
Mailing Address - Country:US
Mailing Address - Phone:800-439-1580
Mailing Address - Fax:
Practice Address - Street 1:111 E MONUMENT AVE
Practice Address - Street 2:STE 401-10
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5774
Practice Address - Country:US
Practice Address - Phone:800-439-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2023-12-06
Deactivation Date:2023-05-23
Deactivation Code:
Reactivation Date:2023-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies