Provider Demographics
NPI:1871736884
Name:KINEX MEDICAL COMPANY LLC
Entity type:Organization
Organization Name:KINEX MEDICAL COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-845-6364
Mailing Address - Street 1:1801 AIRPORT RD
Mailing Address - Street 2:STE 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 1:115 W 86TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7063
Practice Address - Country:US
Practice Address - Phone:800-845-3634
Practice Address - Fax:888-681-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000806A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200420570AMedicaid
IN4360910001Medicare PIN