Healthcare Provider Details

I. General information

NPI: 1669698882
Provider Name (Legal Business Name): KINGSVILLE MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W KLEBERG AVE
KINGSVILLE TX
78363-4427
US

IV. Provider business mailing address

227 W KLEBERG AVE
KINGSVILLE TX
78363-4427
US

V. Phone/Fax

Practice location:
  • Phone: 361-592-6451
  • Fax: 361-595-4545
Mailing address:
  • Phone: 361-592-6451
  • Fax: 361-595-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberH3070
License Number StateTX

VIII. Authorized Official

Name: DR. JEROME K. HEMMERT
Title or Position: PRESIDENT, OWNER
Credential: M.D.
Phone: 361-592-6451