1780687905 NPI number — DR. ROBERT M KIRK M.D.

Table of content: DR. ROBERT M KIRK M.D. (NPI 1780687905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780687905 NPI number — DR. ROBERT M KIRK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRK
Provider First Name:
ROBERT
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780687905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/20/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 E PARRISH AVE
Provider Second Line Business Mailing Address:
STE 450
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42303-3223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-685-3700
Provider Business Mailing Address Fax Number:
270-685-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 E PARRISH AVE
Provider Second Line Business Practice Location Address:
STE 450
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-685-3700
Provider Business Practice Location Address Fax Number:
270-685-0998
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  29104 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64291040 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100028040 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: K011431 . This is a "CHAMPUS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000049966 . This is a "BCBS 12 DIGIT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1463195 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1064356 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18B4 . This is a "BCBS 4 DIGIT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 272388 . This is a "HEALTHLINK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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