1366782161 NPI number — JOHN SIMPSON KILGO III LPC

Table of content: JOHN SIMPSON KILGO III LPC (NPI 1366782161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366782161 NPI number — JOHN SIMPSON KILGO III LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILGO
Provider First Name:
JOHN
Provider Middle Name:
SIMPSON
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
LPC
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:
1366782161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CREEKSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29650-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-881-2329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 MILESTONE WAY SUITE C GREENVILLE, SC 29615
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-6608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-881-2329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2013

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 301100 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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