Provider Demographics
NPI:1053360990
Name:KIMBALL MEDICAL CENTER, INC
Entity type:Organization
Organization Name:KIMBALL MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-557-7119
Mailing Address - Street 1:LOCKBOX 9307, PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9307
Mailing Address - Country:US
Mailing Address - Phone:732-557-7119
Mailing Address - Fax:732-557-7109
Practice Address - Street 1:600 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5237
Practice Address - Country:US
Practice Address - Phone:732-363-1900
Practice Address - Fax:732-942-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7997507Medicaid
NJ7997507Medicaid