Provider Demographics
NPI:1982863262
Name:KING CLINIC INC
Entity Type:Organization
Organization Name:KING CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-5210
Mailing Address - Street 1:1545 HIGHWAY 654
Mailing Address - Street 2:
Mailing Address - City:GHEENS
Mailing Address - State:LA
Mailing Address - Zip Code:70355-2103
Mailing Address - Country:US
Mailing Address - Phone:985-446-5210
Mailing Address - Fax:985-446-8327
Practice Address - Street 1:4608 HIGHWAY 1
Practice Address - Street 2:SUITE 230
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2623
Practice Address - Country:US
Practice Address - Phone:985-537-2636
Practice Address - Fax:985-537-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36742669D207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty