Provider Demographics
NPI:1932220274
Name:KIMBERLY R. PITTS D O P A
Entity Type:Organization
Organization Name:KIMBERLY R. PITTS D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-722-4400
Mailing Address - Street 1:2246 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4208
Mailing Address - Country:US
Mailing Address - Phone:409-722-4400
Mailing Address - Fax:409-722-4409
Practice Address - Street 1:2246 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4208
Practice Address - Country:US
Practice Address - Phone:409-722-4400
Practice Address - Fax:409-722-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027KWOtherBCBS
TX1778375-01Medicaid
TX0027KWOtherBCBS