Provider Demographics
NPI:1215116348
Name:KING MEDICAL GROUP PA
Entity type:Organization
Organization Name:KING MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHY
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-328-7400
Mailing Address - Street 1:9323 GARLAND RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3600
Mailing Address - Country:US
Mailing Address - Phone:214-328-7400
Mailing Address - Fax:214-328-7680
Practice Address - Street 1:9323 GARLAND RD
Practice Address - Street 2:SUITE 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3600
Practice Address - Country:US
Practice Address - Phone:214-328-7400
Practice Address - Fax:214-328-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007QPOtherBCBS
TX00Z2080OtherMEDICARE GROUP PTAN