MEDICARE: KIRKSVILLE CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084N0400X	Neurology Physician
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
3	207RP1001X	Pulmonary Disease Physician
4	207R00000X	Internal Medicine Physician
5	207P00000X	Emergency Medicine Physician
6	207V00000X	Obstetrics & Gynecology Physician
7	208M00000X	Hospitalist Physician
8	207X00000X	Orthopaedic Surgery Physician
9	208000000X	Pediatrics Physician
10	208600000X	Surgery Physician
11	363L00000X	Nurse Practitioner
12	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
13	207RI0011X	Interventional Cardiology Physician
14	207RC0000X	Cardiovascular Disease Physician
15	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	191271	OTHER	MO	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538155817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKSVILLE CLINIC CORP

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-8575
Fax Number	:	615-465-3007

Provider Business Practice Location Address
First Line	:	1607 S BALTIMORE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-4536
Country	:	US
Telephone Number	:	660-627-3363
Fax Number	:	660-785-1927

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BRIAN A PEOPLES
Credential	:
Telephone Number	:	615-465-7585

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	06/27/2012

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