Healthcare Provider Details

I. General information

NPI: 1740305952
Provider Name (Legal Business Name): KRICHEV FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 HIGHWAY 431 S
BROWNSBORO AL
35741-9771
US

IV. Provider business mailing address

5540 HIGHWAY 431 S
BROWNSBORO AL
35741-9771
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-3003
  • Fax: 256-533-3013
Mailing address:
  • Phone: 256-533-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25501
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25501
License Number StateAL

VIII. Authorized Official

Name: DR. JONATHAN EDWARD KRICHEV
Title or Position: PRESIDENT
Credential: MD
Phone: 256-533-3003