Provider Demographics
NPI:1316145022
Name:THE KIRKLAND FAMILY MEDICAL CENTER, PA
Entity type:Organization
Organization Name:THE KIRKLAND FAMILY MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-229-8000
Mailing Address - Street 1:1652 STATE HIGHWAY 22 W
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-2909
Mailing Address - Country:US
Mailing Address - Phone:479-229-8000
Mailing Address - Fax:833-637-1613
Practice Address - Street 1:1652 STATE HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-2909
Practice Address - Country:US
Practice Address - Phone:479-229-8000
Practice Address - Fax:479-477-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0985305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182167002Medicaid
AR5G483Medicare UPIN