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General NPI Number Information
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NPI Number | 1356443477
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Entity Type | Organization
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Legal Business Name | JOHN KILGALLIN M.D.
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 124 DOWELL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-4278
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Country | US
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Telephone | 270-866-3161
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Fax | 270-866-3163
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Provider Business Mailing Address
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Address Line | 124 DOWELL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-4278
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Country | US
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Telephone | 270-866-3161
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Fax | 270-866-3163
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Authorized Official
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Title or Position | OWNER
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Name | JOHN KILGALLIN
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Credential | M.D.
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Telephone | 270-866-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25723
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License Number State | KY
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