Provider Demographics
NPI:1396217865
Name:EKC MEDICAL SERVICES PA
Entity Type:Organization
Organization Name:EKC MEDICAL SERVICES PA
Other - Org Name:DOC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:KYUNG
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-573-1152
Mailing Address - Street 1:290 NICHOLAS PKWY NW STE 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3804
Mailing Address - Country:US
Mailing Address - Phone:239-573-1152
Mailing Address - Fax:239-573-1360
Practice Address - Street 1:290 NICHOLAS PARKWAY NW
Practice Address - Street 2:SUITE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3804
Practice Address - Country:US
Practice Address - Phone:239-573-1152
Practice Address - Fax:239-573-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension SpecialistGroup - Multi-Specialty