Organization Active NPI

Kingman Healthcare, Inc

Doing business as KRMC Community Pharmacy

  • Community/Retail Pharmacy
  • Kingman, AZ
National Provider Identifier
1992286298
Registry record updated Jul 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y007642 Issued in AZ
Legal business name
KINGMAN HEALTHCARE, INC
Doing business as
KRMC Community Pharmacy
Practice address
1739 E Beverly Ave Ste 106
Kingman, AZ 86409-3593
Phone
(928) 681-8778
Fax
(928) 681-8779
NPI assigned
Aug 24, 2018
Last updated
Jul 2, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
KINGMAN HEALTHCARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tim Blanchard
Title
Cfo
Phone
(928) 681-8668

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Y007642 AZ
Clinic Pharmacy 3336C0002X Y007642 AZ
Community/Retail Pharmacy 3336C0003X Y007642 AZ Primary

Addresses

Primary practice location

1739 E Beverly Ave Ste 106
Kingman, AZ 86409-3593

Mailing address

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 757-2101

Other names 2

  • KRMC Community Pharmacy Doing business as
  • Kingman Hospital, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20230801003496 AZ Part B Supplier - Pharmacy 6901791367 Practice locations: Kingman, AZ
O20240523000597 AZ Part B Supplier - Mass Immunization (Roster Biller Only) 6901791367 Practice locations: Kingman, AZ
O20250113001551 AZ DME Supplier - Pharmacy 6901791367 Practice locations: Kingman, AZ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
KRMC Community Pharmacy1739 E Beverly Ave, Kingman, AZ 86409-3593(928) 681-8778 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jun 5, 1998

National Provider Directory

National Provider Directory
Tax ID family
Southwest Medical Imagi5 organizations share this tax ID, including this one
Part of
Southwest Medical Imagi

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1301 W Beale St
#103
Kingman, AZ 86401
Phone (928) 718-5200

1719 E Beverly Ave
Kingman, AZ 86409
Phone (928) 263-5605

1739 E Beverly Ave
Ste 101
Kingman, AZ 86409
Phone (928) 681-8681

1739 E Beverly Ave
Ste 104
Kingman, AZ 86409
Phone (928) 757-5000

1739 E Beverly Ave
Ste 200
Kingman, AZ 86409
Phone (928) 263-4722

1739 E Beverly Ave
Ste 201
Kingman, AZ 86409
Phone (928) 681-8704

1739 E Beverly Ave
Ste 204
Kingman, AZ 86409
Phone (928) 681-8706

1790 Sycamore Ave
Kingman, AZ 86409
Phone (928) 681-8710

2002 N Stockton Hill Rd
Ste 103
Kingman, AZ 86401
Phone (602) 526-0848

2202 N Stockton Hill Rd
Ste 101
Kingman, AZ 86401
Phone (928) 681-8701

2226 Hualapai Mountain Rd
Ste 100
Kingman, AZ 86401
Phone (928) 681-8530

3116 N Stockton Hill Rd
Kingman, AZ 86401
Phone (928) 681-8742

3801 Santa Rosa Dr
Kingman, AZ 86401
Phone (928) 263-5000

3801 Santa Rosa Dr
Ste 103
Kingman, AZ 86401
Phone (928) 681-8742

3801 Santa Rosa Dr
Ste 105
Kingman, AZ 86401
Phone (928) 681-8751

3801 Santa Rosa Dr
Ste 200
Kingman, AZ 86401
Phone (702) 471-7779

3801 Santa Rosa Dr
Ste D
Kingman, AZ 86401
Phone (928) 681-8738

812 Airway Ave
Kingman, AZ 86409
Phone (928) 681-8710

Practitioners & affiliated clinicians

Practitioners 415

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 415

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593648000000",
    "number": "1992286298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3269 N STOCKTON HILL RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093619",
            "telephone_number": "928-757-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1739 E BEVERLY AVE STE 106",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093593",
            "telephone_number": "928-681-8778",
            "fax_number": "928-681-8779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGMAN HEALTHCARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KINGMAN HEALTHCARE, INC",
        "enumeration_date": "2018-08-24",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-681-8668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AZ",
            "license": "Y007642",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "AZ",
            "license": "Y007642",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y007642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KRMC Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kingman Hospital, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.