Provider Demographics
NPI:1154868867
Name:KRUPNICK HEALTHCARE, LLC
Entity type:Organization
Organization Name:KRUPNICK HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KRUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-899-6919
Mailing Address - Street 1:4390 W FORT BRIDGER RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-9038
Mailing Address - Country:US
Mailing Address - Phone:928-899-6919
Mailing Address - Fax:
Practice Address - Street 1:3181 CLEARWATER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7196
Practice Address - Country:US
Practice Address - Phone:928-515-1755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42104261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care