Provider Demographics
NPI:1437403854
Name:AFCOA KINGWOOD, PC
Entity Type:Organization
Organization Name:AFCOA KINGWOOD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-265-9884
Mailing Address - Street 1:1414 GREEN OAK TERRACE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2960
Mailing Address - Country:US
Mailing Address - Phone:281-358-9889
Mailing Address - Fax:
Practice Address - Street 1:1414 GREEN OAK TERRACE CT STE 100
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2960
Practice Address - Country:US
Practice Address - Phone:281-358-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218871602Medicaid
TX218871601Medicaid