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General NPI Number Information
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NPI Number | 1184818221
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Entity Type | Organization
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Legal Business Name | J KIRK & COMPANY P C
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 10512 N 110TH EAST AVE SUITE 100
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City | OWASSO
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State | OK
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Zip | 74055-6636
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Country | US
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Telephone | 918-622-8513
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Fax | 918-622-8552
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | STIGLER
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State | OK
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Zip | 74462-0599
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Country | US
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Telephone | 918-272-6333
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Fax | 918-272-6777
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JOEBOB KIRK
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Credential | DO
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Telephone | 918-272-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 3269
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License Number State | OK
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