Provider Demographics
NPI:1497861454
Name:RIMA KITTLEY, MD
Entity Type:Organization
Organization Name:RIMA KITTLEY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KITTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-5699
Mailing Address - Street 1:PO BOX 152405
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-2405
Mailing Address - Country:US
Mailing Address - Phone:936-634-5699
Mailing Address - Fax:936-634-5659
Practice Address - Street 1:1501 HANKS ST
Practice Address - Street 2:STE B
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5411
Practice Address - Country:US
Practice Address - Phone:936-634-5699
Practice Address - Fax:936-634-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161159202Medicaid
TX8X6840OtherBCBS
TX0070PGOtherBCBS GROUP
TX00Z193Medicare PIN
TX8X6840OtherBCBS