MEDICARE: PATRICK HOLT KING M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	1389	SD
2	207W00000X	Ophthalmology Physician	17531	NE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	NA1114003	OTHER	NE	MEDICARE PTAN NORFOLK, NE
8	NA1115003	OTHER	NE	NE MEDICARE PTAN O'NEILL, NE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1389	OTHER		DAKOTACARE PROVIDER ID
2	22052	OTHER	NE	NE BLUE SHIELD ID
3	0009384	OTHER	SD	SD WELLMARK BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1487657334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK HOLT KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 819
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078-0819
Country	:	US
Telephone Number	:	605-665-9638
Fax Number	:	605-665-0526

Provider Business Practice Location Address
First Line	:	415 W 3RD ST
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078-4201
Country	:	US
Telephone Number	:	605-665-9638
Fax Number	:	605-665-0526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/04/2008