Provider Demographics
NPI:1700075553
Name:2K MEDICAL LLC
Entity Type:Organization
Organization Name:2K MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KLODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-332-0149
Mailing Address - Street 1:9618 SW 34TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8662
Mailing Address - Country:US
Mailing Address - Phone:352-332-0149
Mailing Address - Fax:
Practice Address - Street 1:9618 SW 34TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8662
Practice Address - Country:US
Practice Address - Phone:352-332-0149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty