MEDICARE: KINGMAN HEALTHCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HHA0059	AZ
2	251G00000X	Community Based Hospice Care Agency	SPC3040	AZ
3	293D00000X	Physiological Laboratory	137455	AZ
4	282N00000X	General Acute Care Hospital	H0010	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265423917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGMAN HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	3269 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3619
Country	:	US
Telephone Number	:	928-681-8655
Fax Number	:	928-263-3599

Provider Business Practice Location Address
First Line	:	3269 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3619
Country	:	US
Telephone Number	:	928-681-8655
Fax Number	:	928-263-3599

Authorized Official
Title or Position	:	CFO
Name	:	TIM BLANCHARD
Credential	:
Telephone Number	:	928-681-8668

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/02/2020

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Directions to “KINGMAN HEALTHCARE, INC ” Practice Location

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