Provider Demographics
NPI:1164749966
Name:KING'S COLLEGE
Entity Type:Organization
Organization Name:KING'S COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR STUDENT AFFAIRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCINCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:570-208-5900
Mailing Address - Street 1:133 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0800
Mailing Address - Country:US
Mailing Address - Phone:570-208-5900
Mailing Address - Fax:570-208-5988
Practice Address - Street 1:133 N RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0800
Practice Address - Country:US
Practice Address - Phone:570-208-5900
Practice Address - Fax:570-208-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMA001257L261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health