Provider Demographics
NPI:1063547164
Name:KIRT BIERIG D O INC
Entity type:Organization
Organization Name:KIRT BIERIG D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIERIG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-327-7842
Mailing Address - Street 1:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0952
Mailing Address - Country:US
Mailing Address - Phone:580-327-7842
Mailing Address - Fax:
Practice Address - Street 1:410 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2372
Practice Address - Country:US
Practice Address - Phone:580-327-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK246721201OtherMEDICARE INDIVIDUAL PTAN
OK100736170 AMedicaid
DN3274OtherRAILROAD MEDICARE PTAN
OK100094160 AMedicaid
OK600522385OtherMEDICARE PTAN
OK1316979768Medicare NSC
OK671506501006Medicare Oscar/Certification
OK246721201OtherMEDICARE INDIVIDUAL PTAN
OK100736170 AMedicaid