Basic Information
| Provider Information | |||||||||
| NPI: | 1336491315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | K&S HEALTHCARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHEAST PROHEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7585 KITTY HAWK | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104682333 | ||||||||
| FaxNumber: | 2106674044 | ||||||||
| Practice Location | |||||||||
| Address1: | 7585 KITTY HAWK | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104682333 | ||||||||
| FaxNumber: | 2106674044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2012 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | KYPUROS | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2105994086 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M5312 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.