Provider Demographics
NPI:1053618090
Name:KAMUCK INCORPORATED
Entity type:Organization
Organization Name:KAMUCK INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-8200
Mailing Address - Street 1:509 STERLING HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7476
Mailing Address - Country:US
Mailing Address - Phone:907-235-8200
Mailing Address - Fax:907-235-8203
Practice Address - Street 1:509 STERLING HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7476
Practice Address - Country:US
Practice Address - Phone:907-235-8200
Practice Address - Fax:907-235-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK740316332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies