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General NPI Number Information
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NPI Number | 1942335237
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Entity Type | Organization
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Legal Business Name | KING MEDICAL CARE, INC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 3151 COLUMBIA BLVD SUITE 100
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City | BLOOMSBURG
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State | PA
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Zip | 17815-8889
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Country | US
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Telephone | 570-784-0500
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Fax | 570-784-9563
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Provider Business Mailing Address
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Address Line | 3151 COLUMBIA BLVD SUITE 100
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City | BLOOMSBURG
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State | PA
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Zip | 17815-8889
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Country | US
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Telephone | 570-784-0500
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Fax | 570-784-9563
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. DOYLE WAYNE AVERETT
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Credential |
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Telephone | 570-784-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD430599
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD430581
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License Number State | PA
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