MEDICARE: KIRK KRITNER PAC

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	363A00000X	Physician Assistant	866	CO

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	COW52119	OTHER	CO	ANTHEM BC/BS

General Provider Information

NPI Number	:	1407846405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK KRITNER PAC

Provider Business Mailing Address
First Line	:	106 BLANCA AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2340
Country	:	US
Telephone Number	:	719-589-2511
Fax Number	:	719-587-1372

Provider Business Practice Location Address
First Line	:	106 BLANCA AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2340
Country	:	US
Telephone Number	:	719-589-8053
Fax Number	:	719-587-1372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/01/2012

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Directions to “ KIRK KRITNER PAC” Practice Location

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