NPIMap

Organization Active NPI

Kmci Service Management, LLC

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1588907554
Registry record updated Sep 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M1829 Issued in TX
Legal business name
KMCI SERVICE MANAGEMENT, LLC
Practice address
3131 McKinney Ave
Suite 600
Dallas, TX 75204-7426
Phone
(972) 505-1584
Fax
(682) 422-3020
NPI assigned
Mar 28, 2013
Last updated
Sep 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Avian Deshiver Kidd, MDNPI 1629179312
Title
President
Phone
(972) 505-1584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M1829 TX Primary

Addresses

Primary practice location

3131 McKinney Ave
Suite 600
Dallas, TX 75204-7426

Mailing address

3131 McKinney Ave
Suite 600
Dallas, TX 75204-7426
Phone (972) 505-1584

Other identifiers 1

IdentifierTypeStateIssuer
M1829OtherTXLICENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378339200000",
    "number": "1588907554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 MCKINNEY AVE",
            "address_2": "SUITE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752047426",
            "telephone_number": "972-505-1584",
            "fax_number": "682-422-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 MCKINNEY AVE",
            "address_2": "SUITE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752047426",
            "telephone_number": "972-505-1584",
            "fax_number": "682-422-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMCI SERVICE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-28",
        "last_updated": "2013-09-05",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "AVIAN",
        "authorized_official_middle_name": "DESHIVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-505-1584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M1829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "M1829",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.