1568414092 NPI number — HERBERT A KING II MD

Table of content: HERBERT A KING II MD (NPI 1568414092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568414092 NPI number — HERBERT A KING II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
HERBERT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1568414092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 WATERCOVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23112-3982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-744-0200
Provider Business Mailing Address Fax Number:
804-744-8417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 WATERCOVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23112-3982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-744-0200
Provider Business Practice Location Address Fax Number:
804-744-8417
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101233627 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10002697 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540883363 . This is a "CHAMPUS-TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8115017 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 228897 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 279416 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010006627 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540883363 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 14221 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540883363 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4624531 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540883363 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0103806 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540883363 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540883363 . This is a "PREFERRED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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