Provider Demographics
NPI:1629263314
Name:KUNZ MEDICAL LLC
Entity Type:Organization
Organization Name:KUNZ MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GLANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-779-6801
Mailing Address - Street 1:6 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8603
Mailing Address - Country:US
Mailing Address - Phone:740-779-6801
Mailing Address - Fax:740-779-6804
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8603
Practice Address - Country:US
Practice Address - Phone:740-779-6801
Practice Address - Fax:740-779-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048466Medicaid
OH000000253294OtherANTHEM
OH0104896OtherUHC
OHG76276Medicare UPIN
OH0891974Medicare PIN