Provider Demographics
NPI:1205624939
Name:KRIVANTA LLC
Entity type:Organization
Organization Name:KRIVANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-907-8553
Mailing Address - Street 1:4400 MOULTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 E US HIGHWAY 24 STE E1
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7770
Practice Address - Country:US
Practice Address - Phone:502-907-8553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory