Provider Demographics
NPI:1013908615
Name:PHYSICIANS OF KING'S DAUGHTERS, P.A.
Entity Type:Organization
Organization Name:PHYSICIANS OF KING'S DAUGHTERS, P.A.
Other - Org Name:KING'S DAUGHTERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-298-2682
Mailing Address - Street 1:1905 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1814
Mailing Address - Country:US
Mailing Address - Phone:254-298-2682
Mailing Address - Fax:254-778-7197
Practice Address - Street 1:1905 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-298-2682
Practice Address - Fax:254-778-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0801260001Medicare NSC
5661670003Medicare NSC