Provider Demographics
NPI:1649861576
Name:INDEPENDENCE HEALTHCARE PC
Entity type:Organization
Organization Name:INDEPENDENCE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-6454
Mailing Address - Street 1:291 N FIREWEED ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 N FIREWEED ST STE B
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7570
Practice Address - Country:US
Practice Address - Phone:907-262-6454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENCE HEALTHCARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic