Provider Demographics
NPI:1588709588
Name:JAMES R. KIRKPATRICK,, PLLC
Entity type:Organization
Organization Name:JAMES R. KIRKPATRICK,, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-705-6113
Mailing Address - Street 1:1124 FRENCH TOWN LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4666
Mailing Address - Country:US
Mailing Address - Phone:615-472-1256
Mailing Address - Fax:931-490-7439
Practice Address - Street 1:1218 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6406
Practice Address - Country:US
Practice Address - Phone:931-490-7440
Practice Address - Fax:931-490-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20962208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113671Medicaid
AZ68567Medicare ID - Type Unspecified
AZ113671Medicaid