1639162530 NPI number — THOMAS R KING MD

Table of content: THOMAS R KING MD (NPI 1639162530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639162530 NPI number — THOMAS R KING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
THOMAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1639162530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 DUNN RD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136-6132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-839-5522
Provider Business Mailing Address Fax Number:
314-839-5351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN RD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-839-5522
Provider Business Practice Location Address Fax Number:
314-839-5351
Provider Enumeration Date:
08/25/2005

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: 207RC0000X , with the licence number:  R7F82 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6327V8816 . This is a "HCUSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: E36005 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3156370 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42693V30946 . This is a "HLTHPART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000013834 . This is a "ESSENCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060067901 . This is a "ILRRMCR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 060067902 . This is a "MORRMCR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 206707606 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4334049 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: O21267 . This is a "JFMOLLOY/FMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20502 . This is a "MOBS/BLCHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431098908 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123148 . This is a "HLNK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500128 . This is a "UNC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1955V3831 . This is a "GHP/CMR" identifier . This identifiers is of the category "OTHER".