Healthcare Provider Details

I. General information

NPI: 1205208642
Provider Name (Legal Business Name): KIMS FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E FRANKLIN ST
DU QUOIN IL
62832-2302
US

IV. Provider business mailing address

316 E FRANKLIN ST
DU QUOIN IL
62832-2302
US

V. Phone/Fax

Practice location:
  • Phone: 618-790-9121
  • Fax: 618-790-9178
Mailing address:
  • Phone: 618-790-9121
  • Fax: 618-790-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM S SCHRAMKE
Title or Position: OWNER
Credential: APN
Phone: 573-651-4488