| King City Physician Company, Llc | |
|
4117 S Water Tower Pl Suite C Mount Vernon IL 62864-6567 | |
| (618) 242-0672 | |
| (618) 242-0862 |
| Full Name | King City Physician Company, Llc |
|---|---|
| Speciality | Otolaryngology |
| Location | 4117 S Water Tower Pl, Mount Vernon, Illinois |
| Authorized Official Name and Position | Laura J Fey (SR. DIRECTOR PHYSICIAN REV CYCLE) |
| Authorized Official Contact | 6152213641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| King City Physician Company, Llc 4117 S Water Tower Pl Suite C Mount Vernon IL 62864-6567 Ph: (618) 242-0672 | King City Physician Company, Llc 4117 S Water Tower Pl Suite C Mount Vernon IL 62864-6567 Ph: (618) 242-0672 |
| NPI Number | 1134470859 |
|---|---|
| Provider Enumeration Date | 09/20/2012 |
| Last Update Date | 07/07/2023 |
| Medicare PECOS PAC ID | 1254584154 |
|---|---|
| Medicare Enrollment ID | O20121228000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134470859 | NPI | - | NPPES |
| Provider Name | Jacques Papazian |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1366491193 PECOS PAC ID: 5496768574 Enrollment ID: I20060801000147 |
| Provider Name | David J Lane |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164472155 PECOS PAC ID: 7618978479 Enrollment ID: I20070122000148 |
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