Provider Demographics
NPI:1891074191
Name:K KINIFICK ENT LLC
Entity type:Organization
Organization Name:K KINIFICK ENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN/MGR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:KINIFICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-880-8898
Mailing Address - Street 1:7512 SIGNAL AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113
Mailing Address - Country:US
Mailing Address - Phone:505-880-8898
Mailing Address - Fax:505-881-4952
Practice Address - Street 1:6600 MENAUL BLVD NE STE 700 (INSIDE SEARS)
Practice Address - Street 2:MIRACLE EAR HEARING
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-880-8898
Practice Address - Fax:505-881-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-221541-00-0332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment