NPIMap

Organization Active NPI

King of Prussia Family Medicine

  • Non-Pharmacy Dispensing Site
  • King of Prussia, PA
National Provider Identifier
1710020664
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD029085E Issued in PA
Legal business name
KING OF PRUSSIA FAMILY MEDICINE
Practice address
700 S Henderson Rd
Suite 306
King of Prussia, PA 19406-3530
Phone
(610) 265-0726
NPI assigned
Feb 14, 2007
Organization subpart
Yes
Parent organization
MEDVANTX,INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD029085E PA Primary

Addresses

Primary practice location

700 S Henderson Rd
Suite 306
King of Prussia, PA 19406-3530

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

National Provider Directory

National Provider Directory
Tax ID family
Fornance Physician Services Inc28 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1710020664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S HENDERSON RD",
            "address_2": "SUITE 306",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063530",
            "telephone_number": "610-265-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING OF PRUSSIA FAMILY MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX,INC",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD029085E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.