Provider Demographics
NPI:1205208642
Name:KIMS FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:KIMS FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHRAMKE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:573-651-4488
Mailing Address - Street 1:316 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-2302
Mailing Address - Country:US
Mailing Address - Phone:618-790-9121
Mailing Address - Fax:618-790-9178
Practice Address - Street 1:316 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-2302
Practice Address - Country:US
Practice Address - Phone:618-790-9121
Practice Address - Fax:618-790-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty