MEDICARE: THOMAS R KING MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	R7F82	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6327V8816	OTHER		HCUSA
2	E36005	OTHER		MERCY
3	3156370	OTHER		CIGNA
4	42693V30946	OTHER		HLTHPART
5	000000013834	OTHER		ESSENCE
6	060067901	OTHER	IL	ILRRMCR
7	060067902	OTHER	MO	MORRMCR
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4334049	OTHER		AETNA
10	O21267	OTHER		JFMOLLOY/FMH
11	20502	OTHER	MO	MOBS/BLCHOICE
12	431098908	OTHER		TRICARE
13	123148	OTHER		HLNK
14	2500128	OTHER		UNC
15	1955V3831	OTHER		GHP/CMR

NPI Number	:	1639162530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R KING MD

Provider Business Mailing Address
First Line	:	11125 DUNN RD
Second Line	:	STE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

Provider Business Practice Location Address
First Line	:	11125 DUNN RD
Second Line	:	STE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	12/02/2021

11125 DUNN RD , STE 402
SAINT LOUIS, MO
63136-6132

Practice Phone: 314-741-3400
Practice Fax: 314-741-4357

11125 DUNN RD , STE 204
SAINT LOUIS, MO
63136-6132