| Kim P Lark Do Pc | |
|
2402 W Pierce St Ste 4a Carlsbad NM 88220-3537 | |
| (505) 234-9964 | |
| (505) 234-9962 |
| Full Name | Kim P Lark Do Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2402 W Pierce St, Carlsbad, New Mexico |
| Authorized Official Name and Position | Christi Michelle Yerby (BILLING SPECIALIST) |
| Authorized Official Contact | 5052349964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim P Lark Do Pc 2402 W Pierce St Ste 4a Carlsbad NM 88220-3537 Ph: (505) 234-9964 | Kim P Lark Do Pc 2402 W Pierce St Ste 4a Carlsbad NM 88220-3537 Ph: (505) 234-9964 |
| NPI Number | 1720275357 |
|---|---|
| Provider Enumeration Date | 09/27/2007 |
| Last Update Date | 11/12/2007 |
| Medicare PECOS PAC ID | 7416933106 |
|---|---|
| Medicare Enrollment ID | O20040624001218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720275357 | NPI | - | NPPES |
| 00T9592 | Medicaid | NM | |
| NM004378 | Other | NM | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A110698 (New Mexico) | Primary |
| Provider Name | Kim P Lark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023009016 PECOS PAC ID: 1850377557 Enrollment ID: I20100601000618 |
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