Provider Demographics
NPI:1275694325
Name:THOMAS A KRUPKO MD INC
Entity Type:Organization
Organization Name:THOMAS A KRUPKO MD INC
Other - Org Name:ALLIANCE ORTHOPAEDIC AND SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUITCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-823-4424
Mailing Address - Street 1:149 E SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4219
Mailing Address - Country:US
Mailing Address - Phone:330-823-4424
Mailing Address - Fax:330-823-1179
Practice Address - Street 1:149 E SIMPSON ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4219
Practice Address - Country:US
Practice Address - Phone:330-823-4424
Practice Address - Fax:330-823-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0612626Medicaid
OH=========00OtherBWC
OH0545500001Medicare NSC
OHA82321Medicare UPIN
OH9309801Medicare PIN