Active NPI
Glen King
- Independent Duty Corpsman
- Jacksonville, FL
National Provider Identifier
1902114960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- BLDG H. 2005 Knight Lane
Navy Medicine Support Command
Jacksonville, FL 32212-0140 - Phone
- (843) 228-7068
- NPI assigned
- Sep 23, 2010
- Last updated
- Sep 23, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
BLDG H. 2005 Knight Lane
Navy Medicine Support Command
Jacksonville, FL 32212-0140
Mailing address
31 Park Cir
Bluffton, SC 29910-8011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285200000000",
"number": "1902114960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 PARK CIR",
"city": "BLUFFTON",
"state": "SC",
"postal_code": "299108011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG H. 2005 KNIGHT LANE",
"address_2": "NAVY MEDICINE SUPPORT COMMAND",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322120140",
"telephone_number": "843-228-7068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "GLEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-23",
"last_updated": "2010-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.