Basic Information
| Provider Information | |||||||||
| NPI: | 1629058367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIME | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE, ATTN: CREDENTIALS OFFICE | ||||||||
| City: | FT. CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE, ATTN: EMERGENCY DEPT | ||||||||
| City: | FT. CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267650 | ||||||||
| FaxNumber: | 7195244090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34451 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.