Provider Demographics
NPI:1902158744
Name:CE KING MEDICAL CLINIC
Entity Type:Organization
Organization Name:CE KING MEDICAL CLINIC
Other - Org Name:CE KING MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:CABIOC
Authorized Official - Last Name:GERNALE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-459-9947
Mailing Address - Street 1:8514 C E KING PKWY STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-2350
Mailing Address - Country:US
Mailing Address - Phone:281-459-9947
Mailing Address - Fax:
Practice Address - Street 1:8514 C E KING PKWY STE M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-2350
Practice Address - Country:US
Practice Address - Phone:281-459-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH SPENCER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9049261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659568772OtherNPI
TX11238Medicare UPIN