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Organization
KING CITY PHYSICIAN COMPANY, LLC
Active
Organization
KING CITY PHYSICIAN COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J FEY (SR. DIRECTOR PHYSICIAN REV CYCLE)
(615) 221-3641
Entity
Organization
Contact information
Practice address
4117 S WATER TOWER PL, SUITE C, MOUNT VERNON, IL 62864-6567
(618) 242-0672
(618) 242-0862
Mailing address
4117 S WATER TOWER PL, SUITE C, MOUNT VERNON, IL 62864-6567
(618) 242-0672
(618) 242-0862
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
—
NULL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/20/2012
Last updated
07/07/2023
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