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General NPI Number Information
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NPI Number | 1609066620
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Entity Type | Organization
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Legal Business Name | PHYSICIANS OF KING'S DAUGHTERS, PA
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1905 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-1814
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Country | US
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Telephone | 254-298-2682
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Fax | 254-778-7197
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Provider Business Mailing Address
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Address Line | 1905 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-1814
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Country | US
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Telephone | 254-298-2682
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Fax | 254-778-7197
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Authorized Official
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Title or Position | PRESIDENT BOARD OF DIRECTORS
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Name | EDWARD T. MCCAFFREY
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Credential | DPM
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Telephone | 254-298-2682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 0584
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License Number State | TX
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