1215116348 NPI number — KING MEDICAL GROUP PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215116348 NPI number — KING MEDICAL GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KING MEDICAL GROUP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215116348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9323 GARLAND RD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-328-7400
Provider Business Mailing Address Fax Number:
214-328-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9323 GARLAND RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-328-7400
Provider Business Practice Location Address Fax Number:
214-328-7680
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
DOCTOR OF OSTEOPATHY
Authorized Official Telephone Number:
214-328-7400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H0522 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007QP . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Z2080 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com