Provider Demographics
NPI:1780955997
Name:KIM B. POWERS, D.O., P.A.
Entity type:Organization
Organization Name:KIM B. POWERS, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:BARTHOLOMEW
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-541-0323
Mailing Address - Street 1:7800 66TH ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2101
Mailing Address - Country:US
Mailing Address - Phone:727-541-0323
Mailing Address - Fax:727-541-0336
Practice Address - Street 1:7800 66TH ST N STE 206
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2101
Practice Address - Country:US
Practice Address - Phone:727-541-0323
Practice Address - Fax:727-541-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6697207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF92528Medicare UPIN