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KING CITY PHYSICIAN COMPANY LLC NPI 1134470859


NPI Information

NPI: 1134470859
Provider Name: KING CITY PHYSICIAN COMPANY, LLC
Classification: Otolaryngology - 207YX0007X
Entity Type: Organization

Specialization: Plastic Surgery within the Head & Neck

Address:
4117 S WATER TOWER PL
SUITE C
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 242-0672
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KING CITY PHYSICIAN COMPANY, LLC is a plastic surgery within the head and neck otolaryngology in Mount Vernon, IL. The provider is an otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. KING CITY PHYSICIAN COMPANY, LLC NPI is 1134470859. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4117 S WATER TOWER PL
SUITE C
MOUNT VERNON, IL
ZIP 62864-567
Phone: (618) 242-0672
Fax: (618) 242-0862

The provider's authorized official is Laura J Fey .
The authorized official title is Sr. Director Physician Rev Cycle and has the following contact phone number (615) 221-3641.

The enumeration date for this NPI number is 9/20/2012 and was last updated on 7/7/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineNo
2207R00000XInternal MedicineNo
3207RC0000XInternal MedicineCardiovascular DiseaseNo
4207RP1001XInternal MedicinePulmonary DiseaseNo
52080A0000XPediatricsAdolescent MedicineNo
6208600000XSurgeryNo
7208800000XUrologyNo
8363A00000XPhysician AssistantNo
9363LF0000XNurse PractitionerFamilyNo
10207YX0007XOtolaryngologyPlastic Surgery within the Head & NeckYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.