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NPI Code Detail

MEDICARE: PHYSICIANS OF KING'S DAUGHTERS, PA

MEDICARE: PHYSICIANS OF KING'S DAUGHTERS, PA
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1740406198
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS OF KING'S DAUGHTERS, PA
Provider Business Mailing Address
First Line : 1905 SW H K DODGEN LOOP
Second Line :
City : TEMPLE
State : TX
Zip : 76502-1814
Country : US
Telephone Number : 254-298-2682
Fax Number : 254-778-7197
Provider Business Practice Location Address
First Line : 1300 E 6TH AVE
Second Line :
City : BELTON
State : TX
Zip : 76513-2810
Country : US
Telephone Number : 254-298-2682
Fax Number : 254-778-7197
Authorized Official
Title or Position : PRESIDENT BOARD OF DIRECTORS
Name : DR. EDWARD T. MCCAFFREY
Credential : DPM
Telephone Number : 254-298-2682
Provider Enumeration Date : 04/17/2007
Last Update Date : 08/22/2020

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