1225027089 NPI number — DR. RUTH G KING MD

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 1225027089 NPI number — DR. RUTH G KING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
RUTH
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1225027089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202
Provider Second Line Business Mailing Address:
516 PLYMOUTH RD.
Provider Business Mailing Address City Name:
GWYNEDD VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19437-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-687-6580
Provider Business Mailing Address Fax Number:
215-646-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 SOUTH 40TH STR.
Provider Second Line Business Practice Location Address:
CHILDREN'S BEHAVIORAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-596-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2005

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: 2084P0804X , with the licence number:  034884 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD438835 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001294636 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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