Provider Demographics
NPI:1669681854
Name:KING MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:KING MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER COOWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZARATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-983-3113
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:202 SCENIC DRIVE
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021
Mailing Address - Country:US
Mailing Address - Phone:336-983-3113
Mailing Address - Fax:336-985-5042
Practice Address - Street 1:202 SCENIC DRIVE
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-983-3113
Practice Address - Fax:336-985-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19303207Q00000X
NC22149207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890174HMedicaid
NC2309981Medicare ID - Type Unspecified