Provider Demographics
NPI:1609450345
Name:KINGSLEY CLINIC OF FLORIDA LLC
Entity Type:Organization
Organization Name:KINGSLEY CLINIC OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-305-7637
Mailing Address - Street 1:33471 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1849
Mailing Address - Country:US
Mailing Address - Phone:530-305-7637
Mailing Address - Fax:
Practice Address - Street 1:5550 GLADES RD STE 500
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7277
Practice Address - Country:US
Practice Address - Phone:530-305-7637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty