Basic Information
| Provider Information | |||||||||
| NPI: | 1326201500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TERRY D. KING, MD AMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PAVILION RD | ||||||||
| Address2: | |||||||||
| City: | WEST MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712929470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183231100 | ||||||||
| FaxNumber: | 3183231161 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PAVILION RD | ||||||||
| Address2: | |||||||||
| City: | WEST MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712929470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183231100 | ||||||||
| FaxNumber: | 3183231161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | BATSON | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3183231100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PNP-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | MD.02443R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1442399 | 05 | LA | MEDICAID |