Provider Demographics
NPI:1740305952
Name:KRICHEV FAMILY MEDICINE PC
Entity type:Organization
Organization Name:KRICHEV FAMILY MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KRICHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-3003
Mailing Address - Street 1:5540 HIGHWAY 431 S
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741-9771
Mailing Address - Country:US
Mailing Address - Phone:256-533-3003
Mailing Address - Fax:
Practice Address - Street 1:5540 HIGHWAY 431 S
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9771
Practice Address - Country:US
Practice Address - Phone:256-533-3003
Practice Address - Fax:256-533-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25501207QS0010X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6376310001Medicare NSC