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General NPI Number Information
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NPI Number | 1114239969
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Entity Type | Organization
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Legal Business Name | TKC HOLDINGS LLC
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 412 WHIPPLE ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1712
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Country | US
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Telephone | 928-771-9365
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Fax |
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Provider Business Mailing Address
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Address Line | 412 WHIPPLE ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1712
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Country | US
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Telephone | 928-771-9365
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL L HAM
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Credential |
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Telephone | 928-771-9365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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