1831243153 NPI number — GAIL KING MD PC

Table of content: (NPI 1831243153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831243153 NPI number — GAIL KING MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAIL KING MD PC
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:
1831243153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81602-0111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-945-1443
Provider Business Mailing Address Fax Number:
970-947-9410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W MAIN ST
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
ASPEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81611-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-925-8005
Provider Business Practice Location Address Fax Number:
970-920-1652
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOST
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL CODER, BILLER
Authorized Official Telephone Number:
970-945-1443

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77428064 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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