MEDICARE: DR. MATTHEW J KING M.D.

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	207R00000X	Internal Medicine Physician	35889	KY
2	208000000X	Pediatrics Physician	35889	KY
3	208000000X	Pediatrics Physician	39208	TN
4	207R00000X	Internal Medicine Physician	39208	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4096784	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932101284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J KING M.D.

Provider Business Mailing Address
First Line	:	3300 WILLIAMS ENTERPRISE DR STE 1
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4224
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:	931-854-0907

Provider Business Practice Location Address
First Line	:	3300 WILLIAMS ENTERPRISE DR STE 1
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4224
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:	931-854-0907

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/22/2024

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