Healthcare Provider Details

I. General information

NPI: 1730189978
Provider Name (Legal Business Name): VINCENT KIRKHART PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-8608
US

IV. Provider business mailing address

4155 ROWANND RD.
COLUMBUS OH
43214
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 614-442-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001151
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: