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General NPI Number Information
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NPI Number | 1205208642
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Entity Type | Organization
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Legal Business Name | KIMS FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 316 E FRANKLIN ST
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City | DU QUOIN
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State | IL
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Zip | 62832-2302
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Country | US
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Telephone | 618-790-9121
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Fax | 618-790-9178
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Provider Business Mailing Address
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Address Line | 316 E FRANKLIN ST
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City | DU QUOIN
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State | IL
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Zip | 62832-2302
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Country | US
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Telephone | 618-790-9121
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Fax | 618-790-9178
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Authorized Official
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Title or Position | OWNER
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Name | KIM S SCHRAMKE
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Credential | APN
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Telephone | 573-651-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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