Provider Demographics
NPI:1053435180
Name:KIGHTS MEDICAL CORP
Entity type:Organization
Organization Name:KIGHTS MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-878-6666
Mailing Address - Street 1:3222 WELLINGTON CT
Mailing Address - Street 2:STE. A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4124
Mailing Address - Country:US
Mailing Address - Phone:919-878-6666
Mailing Address - Fax:919-878-4411
Practice Address - Street 1:572 GRIFFITH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3546
Practice Address - Country:US
Practice Address - Phone:800-848-1179
Practice Address - Fax:704-525-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00562332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2019Medicaid
NC15527OtherWELLPATH
NC0303780332OtherDEPT. OF LABOR
NC0464TOtherBCBS NC
NC15527OtherWELLPATH