KMART (NPI# 1124456884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124456884 |
| Entity Type | Organization |
| Organization Name | KMART |
| Other Organization Name | KMART PHARMACY |
| Practice Address |
613 First National St Ironwood MI 49938-3329 |
| Practice Telephone | 2409943121 |
| Mailing Telephone | 2409943121 |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |
| Authorized Official Name | DR. KELECHI A AGUWA (PHARMACY MANAGER) |
| Authorized Official Telephone | 2409943121 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | 530241688 | MI | Managed Care Organizations |
| Other Name | Type Code |
|---|---|
| Kmart Pharmacy | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669704920 | Kmart | Pharmacy | 2716 Madison Ave, Indianapolis, IN 46225-2113 | 2010-02-10 |
| 1275734972 | Kmart | Pharmacist | 10501 Pines Blvd, Pembroke Pines, FL 33026 | 2007-05-30 |
| 1902358658 | Kmart | Pharmacist | 528 W Plank Rd, Altoona, PA 16602-2802 | 2016-10-28 |
| 1669922175 | Kmart | Pharmacy | 185 Upper River Rd, Gallipolis, OH 45631-1836 | 2016-10-07 |
| 1235583782 | Kmart | Pharmacist | 1801 W Alexis Rd, Toledo, OH 43613-2302 | 2016-04-21 |
| 1891149241 | Kmart | Pharmacist | 3801 Harmont Ave Ne, Canton, OH 44705-4331 | 2016-04-21 |
| 1437503083 | Kmart | Pharmacist | 210 W Mercury Blvd, Hampton, VA 23669-2513 | 2016-04-20 |
| 1891149670 | Kmart | Pharmacy | 4715 Nine Mile Rd, Richmond, VA 23223-4908 | 2016-04-19 |
| 1609239136 | Kmart | Pharmacist | 1801 W Alexis Rd, Toledo, OH 43613-2302 | 2016-04-01 |
| 1700259728 | Kmart | Pharmacy | 4715 Nine Mile Rd, Richmond, VA 23223-4908 | 2015-11-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KMART | 3333 Beverly Road, Hoffman Estates, IL 60179 |
| Massachusetts Corporations | KMART APPAREL FASHION CORP. | 7373 West Side Avenue, North Bergen, NJ 07047 |
| Virginia Business Entities | KMART APPAREL FASHIONS CORP. | 1209 Orange St, Wilmington, Delaware |
| Oklahoma Business Registrations | KMART APPAREL FASHIONS CORP. | Kmart, 7373 W. Side Ave, North Bergen, NJ 07047-0000 |
| Vermont Business Registrations | KMART APPAREL FASHIONS CORP. | 1209 Orange St., Wilmington, DE 19801 |
| Connecticut Business Registrations | KMART APPAREL FASHIONS CORP. | 7373 Westside Ave, North Bergen, NJ 07047 |
| Vermont Business Registrations | KMART CORPORATION | 3333 Beverly Rd., Hoffman Estates, IL 60179 |
| Oklahoma Business Registrations | KMART CORPORATION | 3100 W. Big Beaver Rd., Troy, MI 48084 |
| Massachusetts Corporations | KMART LOGISTICS SERVICES, INC. | 3100 W. Big Beaver, Troy, MI 48084 |
| Washington State Corporations | KMART OF WASHINGTON LLC | 3333 Beverly Rd, Hoffman Estates, IL 60179 |
| Street Address |
613 FIRST NATIONAL ST |
| City | IRONWOOD |
| State | MI |
| Zip Code | 49938-3329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891319661 | Jonathon Rulseh | Physical Therapy Assistant | 10561 Grandview Ln, Ironwood, MI 49938 | 2020-06-08 |
| 1295107704 | Susanna Lee Harris | Counselor | 220 Roosevelt St, Ironwood, MI 49938 | 2015-10-22 |
| 1609214600 | Eve J. Komosa | Physician Assistant | N. 10561 Grand View Lane, Aspirus Grand View, Ironwood, MI 49938 | 2013-06-12 |
| 1255629861 | Tatyana G Bombard | Radiology | Aspirus Ironwood Hospital, N10561 Grand View Lane, Ironwood, MI 49938 | 2011-07-17 |
| 1205140761 | Allison Harr | Advanced Practice Midwife | N 10565 Grandview Lane, Ironwood, MI 49938 | 2010-07-27 |
| 1821267956 | Great Lakes Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 220 Rooselvelt Street, Ironwood, MI 49938 | 2008-02-22 |
| 1215106349 | Great Lakes Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 427 S. Stephenson Avenue, Suite 214, Iron Mountain, MI 49938 | 2008-02-22 |
| 1740466176 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 10305 Country Club Road, Ironwood, MI 49938 | 2008-01-16 |
| 1396811121 | Rebecca Lynn Mika | Occupational Therapist | 1310 E Cloverland Dr, Ironwood, MI 49938 | 2006-11-24 |
| 1306940432 | Marsha Miller Toohey | Chiropractor | 129 E Ayer St, Ironwood, MI 49938 | 2006-09-11 |
| Find all providers in zip 49938 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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|---|---|---|---|---|
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| 1093228124 | Khidmah LLC | Point of Service | 9315 Joseph Campau St, Hamtramck, MI 48212-3433 | 2017-11-11 |
| 1508307273 | Central Michigan University | Point of Service | 203 E Broomfield, Rose 145, Mt Pleasant, MI 48859-0001 | 2017-03-15 |
| 1083159545 | Marley Gannon Pagel Lmsw, Acsw, LLC | Point of Service | 474 Iris Ln, Saline, MI 48176-9092 | 2016-12-19 |
| 1295277663 | Oceansblue 24 Hr Home Care 4 | Point of Service | 15336 Washburn St, Detroit, MI 48238-1662 | 2016-11-16 |
| 1720434384 | Kelly Mcclain | Point of Service | 2125 Denwood Ave Sw, Wyoming, MI 49509-1962 | 2016-05-12 |
| 1902266356 | Central Michigan Care | Point of Service | 798 S Whiteville Rd, Mt Pleasant, MI 48858-8776 | 2016-02-28 |
| 1073982070 | Bellis | Point of Service | 33037 Grand River Ave, Farmington, MI 48336-3119 | 2015-09-20 |
| 1740666098 | Nariman Shamoon | Point of Service | 14585 Sparrow Dr, Shelby Township, MI 48315-5042 | 2015-08-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.