Provider Demographics
NPI:1134383482
Name:KING FAMILY HEALTHCARE, INC.
Entity type:Organization
Organization Name:KING FAMILY HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:662-665-0006
Mailing Address - Street 1:815 CHILDS ST
Mailing Address - Street 2:PO BOX 1854
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4934
Mailing Address - Country:US
Mailing Address - Phone:662-665-0006
Mailing Address - Fax:662-665-9151
Practice Address - Street 1:815 CHILDS STREET
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3720
Practice Address - Country:US
Practice Address - Phone:662-665-0006
Practice Address - Fax:662-665-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QM0855X
MSR568031261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
428040637BOtherBCBS
MS00119995Medicaid
500000543OtherMEDICARE
MSS44159OtherUPIN