1437341625 NPI number — KARMACK LLC

Table of content: (NPI 1437341625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437341625 NPI number — KARMACK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARMACK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEIL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437341625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 COPELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54603-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-784-5249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 COPELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54603-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-784-5249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEIL
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
HALLER
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
608-784-5249

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  30525 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1790766301 . This is a "PERSONAL NPI" identifier . This identifiers is of the category "OTHER".