=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073892915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN C KINARD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2011
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1514 E ALEXANDER LOVE HWY SUITE 116
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29745-7769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-628-2220
-----------------------------------------------------
Fax | 802-628-2224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 BEN CASEY DR SUITE127
-----------------------------------------------------
City | FORT MILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29708-8561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-802-5855
-----------------------------------------------------
Fax | 803-802-5869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6502S
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------