MEDICARE: KIRK GILLISPIE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1821847088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK GILLISPIE

Provider Business Mailing Address
First Line	:	4503 E 126TH ST
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-6905
Country	:	US
Telephone Number	:	216-609-8383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4503 E 126TH ST
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-6905
Country	:	US
Telephone Number	:	216-609-8383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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Directions to “ KIRK GILLISPIE ” Practice Location

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