NPIMap

Organization Active NPI

Kingsford Physician Services, LLC

  • Hospitalist Physician
  • Pulaski, VA
National Provider Identifier
1871088526
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
KINGSFORD PHYSICIAN SERVICES, LLC
Practice address
2400 Lee Hwy N
Pulaski, VA 24301-2326
Phone
(540) 994-8100
NPI assigned
Jun 26, 2018
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2400 Lee Hwy N
Pulaski, VA 24301-2326

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other identifiers 1

IdentifierTypeStateIssuer
1871088526MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180927000385 VA Part B Supplier - Clinic/Group Practice 0840541017 Receives reassigned benefits from 112 practitioners
Practice locations: Pulaski, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 114

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.

View all 114

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1871088526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 LEE HWY N",
            "city": "PULASKI",
            "state": "VA",
            "postal_code": "243012326",
            "telephone_number": "540-994-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSFORD PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-26",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871088526",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pulaski, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.