MEDICARE: JACOB KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1407709314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB KING

Provider Business Mailing Address
First Line	:	821 W F ST
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-5239
Country	:	US
Telephone Number	:	531-207-3875
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 W F ST
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-5239
Country	:	US
Telephone Number	:	531-207-3875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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Directions to “ JACOB KING ” Practice Location

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