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General NPI Number Information
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NPI Number | 1215464417
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Entity Type | Organization
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Legal Business Name | VALIDUS HEALTH, PA
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 725 N MAIN ST STE 2
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City | BOERNE
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State | TX
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Zip | 78006-1623
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Country | US
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Telephone | 888-712-1047
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Fax |
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Provider Business Mailing Address
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Address Line | 725 N MAIN ST STE 2
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City | BOERNE
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State | TX
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Zip | 78006-1623
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Country | US
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Telephone | 888-712-1047
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KEN KINGDON
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Credential | MD
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Telephone | 619-300-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P4471
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License Number State | TX
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