1033319371 NPI number — MR. TEK HOBERT KILGORE JR. APRN

Table of content: MR. TEK HOBERT KILGORE JR. APRN (NPI 1033319371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033319371 NPI number — MR. TEK HOBERT KILGORE JR. APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILGORE
Provider First Name:
TEK
Provider Middle Name:
HOBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILGORE
Provider Other First Name:
KENNETH
Provider Other Middle Name:
HOBERT
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033319371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 FOOTHILL DRIVE
Provider Second Line Business Mailing Address:
LEVEL 1
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-581-6431
Provider Business Mailing Address Fax Number:
801-585-5294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 FOOTHILL DRIVE
Provider Second Line Business Practice Location Address:
STUDEN HEALTH CENTER
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-6431
Provider Business Practice Location Address Fax Number:
801-585-5294
Provider Enumeration Date:
07/24/2007

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: 363LP2300X , with the licence number:  215876-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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