Healthcare Provider Details

I. General information

NPI: 1366656746
Provider Name (Legal Business Name): KHOT MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 D SCHOOL ST
WILKESBORO NC
28697
US

IV. Provider business mailing address

PO BOX 327 KHOT MEDICAL CLINIC
KING NC
27021
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-9990
  • Fax: 336-838-9995
Mailing address:
  • Phone: 336-838-9990
  • Fax: 336-838-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number19016
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19016
License Number StateNC

VIII. Authorized Official

Name: DR. PRAKASH N KHOT
Title or Position: DOCTOR
Credential:
Phone: 336-838-9990