Healthcare Provider Details

I. General information

NPI: 1881638906
Provider Name (Legal Business Name): KIRK L. PYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PUBLIC SQUARE EAST
WAYNESBORO TN
38485-1202
US

IV. Provider business mailing address

P.O. BOX 1202 118 PUBLIC SQUARE EAST
WAYNESBORO TN
38485-1202
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5575
  • Fax: 931-722-5548
Mailing address:
  • Phone: 931-722-5575
  • Fax: 931-722-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number291U00000X
License Number StateTN

VIII. Authorized Official

Name: KIRK L PYLE
Title or Position: OWNER
Credential:
Phone: 931-722-5575