Provider Demographics
NPI:1194966747
Name:CAROLINE KINGSTON MD MPH FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:CAROLINE KINGSTON MD MPH FAMILY PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:505-820-2562
Mailing Address - Street 1:460 SAINT MICHAELS DR
Mailing Address - Street 2:1204
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7619
Mailing Address - Country:US
Mailing Address - Phone:505-820-2562
Mailing Address - Fax:505-986-0904
Practice Address - Street 1:460 SAINT MICHAELS DR
Practice Address - Street 2:1204
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7619
Practice Address - Country:US
Practice Address - Phone:505-820-2562
Practice Address - Fax:505-986-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-89261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center