1629251376 NPI number — JAMES D KING

Table of content: (NPI 1629251376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629251376 NPI number — JAMES D KING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES D KING
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:
ZIA ANESTHESIA SERVICES
Provider Other Organization Name Type Code:
5
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:
1629251376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-686-5550
Provider Business Mailing Address Fax Number:
573-686-2139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 INDIAN WELLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-5550
Provider Business Practice Location Address Fax Number:
573-686-2139
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-686-5550

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R28228 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 430050356 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM006068 . This is a "NM BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 00093773 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 93773 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177768600 . This is a "DOL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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