Provider Demographics
NPI:1629251376
Name:JAMES D KING
Entity Type:Organization
Organization Name:JAMES D KING
Other - Org Name:ZIA ANESTHESIA SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:573-686-5550
Mailing Address - Street 1:209 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5831
Mailing Address - Country:US
Mailing Address - Phone:573-686-5550
Mailing Address - Fax:573-686-2139
Practice Address - Street 1:2301 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4611
Practice Address - Country:US
Practice Address - Phone:573-686-5550
Practice Address - Fax:573-686-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28228367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM430050356OtherRAILROAD MEDICARE
NMNM006068OtherNM BCBS
NM00093773Medicaid
NM93773Medicaid
NM177768600OtherDOL
NM5459425183Medicare PIN