Basic Information
| Provider Information | |||||||||
| NPI: | 1700070281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | K & G ENTERPRISES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 N MAIN AVE | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125712 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1222 N MAIN AVE | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102717411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | GILYARD | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2102717411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | MT040302 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Military Health Care Provider |
No ID Information.