Provider Demographics
NPI:1295911733
Name:KIM TUNELL LLC
Entity type:Organization
Organization Name:KIM TUNELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-428-1702
Mailing Address - Street 1:2081 W US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5445
Mailing Address - Country:US
Mailing Address - Phone:928-428-1702
Mailing Address - Fax:480-705-7300
Practice Address - Street 1:2081 W US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5445
Practice Address - Country:US
Practice Address - Phone:928-428-1702
Practice Address - Fax:480-705-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3493146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00150682OtherRAILROAD MEDICARE
AZP00150682OtherRAILROAD MEDICARE