Provider Demographics
NPI:1881445807
Name:AIM HEALTHCARE PROVIDERS YUMA CLINIC, LLC
Entity type:Organization
Organization Name:AIM HEALTHCARE PROVIDERS YUMA CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-494-2465
Mailing Address - Street 1:161 E RIVULON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0087
Mailing Address - Country:US
Mailing Address - Phone:804-942-4654
Mailing Address - Fax:
Practice Address - Street 1:1200 S CASTLE DOME AVE STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-5305
Practice Address - Country:US
Practice Address - Phone:928-275-8769
Practice Address - Fax:928-569-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty