Provider Demographics
NPI:1851787915
Name:KING OF PRUSSIA AS, LLC
Entity Type:Organization
Organization Name:KING OF PRUSSIA AS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-205-8221
Mailing Address - Street 1:1000 FIRST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1333
Mailing Address - Country:US
Mailing Address - Phone:610-337-7662
Mailing Address - Fax:
Practice Address - Street 1:1000 FIRST AVE
Practice Address - Street 2:STE 100
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1333
Practice Address - Country:US
Practice Address - Phone:610-337-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty