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General NPI Number Information
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NPI Number | 1104582287
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Entity Type | Organization
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Legal Business Name | KING CAPITAL INC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 895 HYDE PARK AVE
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City | HYDE PARK
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State | MA
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Zip | 02136-3368
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Country | US
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Telephone | 203-257-9728
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Fax | 803-932-9618
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Provider Business Mailing Address
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Address Line | 93 HIGH ST
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City | GLOUCESTER
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State | MA
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Zip | 01930-1165
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Country | US
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Telephone | 203-257-9728
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Fax | 803-932-9618
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Authorized Official
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Title or Position | OWNER
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Name | KING EDWARD ROGERS
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Credential | PT
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Telephone | 203-257-9728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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