1871686782 NPI number — TIMOTHY A KIRK DPM

Table of content: TIMOTHY A KIRK DPM (NPI 1871686782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871686782 NPI number — TIMOTHY A KIRK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRK
Provider First Name:
TIMOTHY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1871686782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5TH AND MONTGOMERY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BOYERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19512-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-367-7000
Provider Business Mailing Address Fax Number:
610-367-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH AND MONTGOMERY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BOYERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19512-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-367-7000
Provider Business Practice Location Address Fax Number:
610-367-4559
Provider Enumeration Date:
10/02/2006

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: 213E00000X , with the licence number:  SC004605L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: SC004605L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 50074067 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2400406000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1732823 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2400406 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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