Provider Demographics
NPI:1861148447
Name:CRUCIALIST ARIZONA LLC
Entity type:Organization
Organization Name:CRUCIALIST ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-329-1942
Mailing Address - Street 1:4230 PABLO PROFESSIONAL CT STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3223
Mailing Address - Country:US
Mailing Address - Phone:904-329-1942
Mailing Address - Fax:
Practice Address - Street 1:4230 PABLO PROFESSIONAL CT STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3223
Practice Address - Country:US
Practice Address - Phone:904-329-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care