Organization
KING MEDICAL CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOYLE WAYNE AVERETT (OFFICE MANAGER)
(570) 784-0500
Entity
Organization
Contact information
Practice address
3151 COLUMBIA BLVD, SUITE 100, BLOOMSBURG, PA 17815-8889
(570) 784-0500
(570) 784-9563
Mailing address
3151 COLUMBIA BLVD, SUITE 100, BLOOMSBURG, PA 17815-8889
(570) 784-0500
(570) 784-9563
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD430581
PA
174400000X
Specialist
MD430599
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114960432
NPI PETER SEIDENBERG
—
01
—
1841364890
NPI JENNIFER SEIDENBERG
—
Enumeration date
02/23/2007
Last updated
07/20/2007
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