Provider Demographics
NPI:1194548511
Name:KINGDOM MEDICAL
Entity type:Organization
Organization Name:KINGDOM MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:813-495-0677
Mailing Address - Street 1:PO BOX 153072
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-3072
Mailing Address - Country:US
Mailing Address - Phone:813-434-1045
Mailing Address - Fax:813-434-1259
Practice Address - Street 1:501 S FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-8055
Practice Address - Country:US
Practice Address - Phone:813-434-1045
Practice Address - Fax:813-434-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies