Provider Demographics
NPI:1528768579
Name:KINGS MEDICALS LLC
Entity type:Organization
Organization Name:KINGS MEDICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, FNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIZIMAKO
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:757-831-8653
Mailing Address - Street 1:9446 MERRIMONT TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2902
Mailing Address - Country:US
Mailing Address - Phone:757-831-8653
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT STE 404
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2052
Practice Address - Country:US
Practice Address - Phone:757-831-8653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service