Provider Demographics
NPI:1760703805
Name:KINGMAN HEALTHCARE, INC
Entity Type:Organization
Organization Name:KINGMAN HEALTHCARE, INC
Other - Org Name:KINGMAN HOSPITAL, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-681-8668
Mailing Address - Street 1:1739 E BEVERLY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-753-3303
Mailing Address - Fax:928-753-3603
Practice Address - Street 1:1726 E BEVERLY AVE STE A
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3500
Practice Address - Country:US
Practice Address - Phone:928-753-3303
Practice Address - Fax:928-753-3603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGMAN HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-11
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care