1295213841 NPI number — G. KAMEN MEDICAL SERVICES AND URGENT CARE ON DEMAND PC

Table of content: (NPI 1295213841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295213841 NPI number — G. KAMEN MEDICAL SERVICES AND URGENT CARE ON DEMAND PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. KAMEN MEDICAL SERVICES AND URGENT CARE ON DEMAND 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:
1295213841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16858
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28816-0858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-551-9331
Provider Business Mailing Address Fax Number:
800-515-1908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1787 OCEANAIRE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-888-1073
Provider Business Practice Location Address Fax Number:
877-253-0737
Provider Enumeration Date:
08/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KAMEN
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
805-888-1073

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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