Provider Demographics
NPI:1902234438
Name:SIRIUS HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:SIRIUS HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KRUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FNP
Authorized Official - Phone:928-515-1755
Mailing Address - Street 1:3181 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7196
Mailing Address - Country:US
Mailing Address - Phone:928-515-1755
Mailing Address - Fax:928-515-2455
Practice Address - Street 1:3181 CLEARWATER DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-515-1755
Practice Address - Fax:928-515-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT043346203 0078OtherCIGNA
VTKRUP05338662OtherBLUE CROSS BLUE SHIELD
VTONP1198Medicaid
VT043346203012OtherTRICARE
VTMB0243991OtherDEA
VTMB0243991OtherDEA