Provider Demographics
NPI:1326201500
Name:TERRY D. KING, MD AMC
Entity Type:Organization
Organization Name:TERRY D. KING, MD AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:BATSON
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PNP-BC
Authorized Official - Phone:318-323-1100
Mailing Address - Street 1:300 PAVILION RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-9470
Mailing Address - Country:US
Mailing Address - Phone:318-323-1100
Mailing Address - Fax:318-323-1161
Practice Address - Street 1:300 PAVILION RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-9470
Practice Address - Country:US
Practice Address - Phone:318-323-1100
Practice Address - Fax:318-323-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.02443R2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442399Medicaid