Provider Demographics
NPI:1710411202
Name:KINGMAN HOSPITAL INC
Entity Type:Organization
Organization Name:KINGMAN HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OSTEOPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAUNTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDINHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-391-6493
Mailing Address - Street 1:6907 E LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6635
Mailing Address - Country:US
Mailing Address - Phone:808-391-6493
Mailing Address - Fax:
Practice Address - Street 1:3269 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3619
Practice Address - Country:US
Practice Address - Phone:928-757-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital