Basic Information
| Provider Information | |||||||||
| NPI: | 1467653709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N FANT ST | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121417 | ||||||||
| FaxNumber: | 8645121896 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N FANT ST | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121335 | ||||||||
| FaxNumber: | 8645128575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | TL32571 | SC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | BP1-0026361 | 01 | INSTITUTIONAL PERMIT | OTHER | NPI# | 01 | SC | BLUE CHOICE | OTHER | NPI # | 01 | SC | TRICARE | OTHER | P00911156 | 01 | SC | RAILROAD MEDICARE | OTHER | 30078070 | 01 | SC | SELECT HEALTH | OTHER | 325712 | 05 | SC | MEDICAID | 551925191A | 05 | GA | MEDICAID | NPI #/ SSN# | 01 | SC | BLUE CROSS | OTHER |