1467690545 NPI number — KCM VENTURES

Table of content: KATIA ANTONINE FORBIN MD (NPI 1326188822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467690545 NPI number — KCM VENTURES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KCM VENTURES
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:
6
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:
1467690545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3224C N COLLEGE RD
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28405-8826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-274-1313
Provider Business Mailing Address Fax Number:
910-790-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3210 OAKLEY CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE HAYNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28429-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-274-1313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STONE
Authorized Official First Name:
CAMERON
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
910-274-1313

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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