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General NPI Number Information
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NPI Number | 1982811543
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Entity Type | Organization
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Legal Business Name | KIRK MEDICAL CLINIC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 1102 WEST SOUTH ST SUITE B
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-776-8545
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Fax | 501-776-1619
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Provider Business Mailing Address
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Address Line | 1102 WEST SOUTH ST SUITE B
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-776-8545
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Fax | 501-776-1619
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Authorized Official
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Title or Position | OWNER
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Name | MARVIN N. KIRK
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Credential | M.D.
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Telephone | 501-776-8545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C4039
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License Number State | AR
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