Provider Demographics
NPI:1396727624
Name:ALLEN B KING A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALLEN B KING A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-769-9355
Mailing Address - Street 1:1260 S MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2288
Mailing Address - Country:US
Mailing Address - Phone:831-769-9355
Mailing Address - Fax:831-754-4955
Practice Address - Street 1:1260 S MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2288
Practice Address - Country:US
Practice Address - Phone:831-769-9355
Practice Address - Fax:831-754-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65061ZOtherBLUE SHIELD GROUP #
CAZZZ24037ZMedicare ID - Type UnspecifiedMCARE GROUP #