Basic Information
Provider Information | |||||||||
NPI: | 1902987647 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KING | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | H.I.S. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5000 CHESHIRE LANE N | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | MN | ||||||||
PostalCode: | 55446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8883339152 | ||||||||
FaxNumber: | 7632684240 | ||||||||
Practice Location | |||||||||
Address1: | 1110 HIGHWAY 55 | ||||||||
Address2: | SUITE 103 | ||||||||
City: | HASTINGS | ||||||||
State: | MN | ||||||||
PostalCode: | 550332371 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6514373239 | ||||||||
FaxNumber: | 6514371066 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/18/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2247 | MN | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.