Provider Demographics
NPI:1245269349
Name:EDMUND KRASINSKI, JR., D.O., P.L.L.C.
Entity type:Organization
Organization Name:EDMUND KRASINSKI, JR., D.O., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASINSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:520-531-0600
Mailing Address - Street 1:PO BOX 36234
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6234
Mailing Address - Country:US
Mailing Address - Phone:520-531-0600
Mailing Address - Fax:520-531-1190
Practice Address - Street 1:6879 N ORACLE RD
Practice Address - Street 2:SUITE 133
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4284
Practice Address - Country:US
Practice Address - Phone:520-531-0600
Practice Address - Fax:520-531-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106788Medicare PIN