Provider Demographics
NPI:1063665255
Name:KEN J TOMPKINS MD PC
Entity Type:Organization
Organization Name:KEN J TOMPKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-825-1440
Mailing Address - Street 1:5589 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3996
Mailing Address - Country:US
Mailing Address - Phone:252-715-0610
Mailing Address - Fax:252-715-0612
Practice Address - Street 1:5589 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3996
Practice Address - Country:US
Practice Address - Phone:252-715-0610
Practice Address - Fax:252-715-0612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEN J TOMPKINS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013XMMedicaid
NC013XMOtherCLAIMS PROCESSING CONTRACTOR
NC89013XMMedicaid
VAC04588Medicare PIN
NC013XMOtherCLAIMS PROCESSING CONTRACTOR
NC2003292Medicare PIN