Provider Demographics
NPI:1982015822
Name:KENNETH C ROMNEY MD INC
Entity Type:Organization
Organization Name:KENNETH C ROMNEY MD INC
Other - Org Name:THE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROMNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-736-3362
Mailing Address - Street 1:526 SHOUP AVE W STE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5050
Mailing Address - Country:US
Mailing Address - Phone:208-736-3362
Mailing Address - Fax:208-736-3382
Practice Address - Street 1:526 SHOUP AVE W STE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-736-3362
Practice Address - Fax:208-736-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11134261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty