MEDICARE: DR. DEREK T KIRBY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	2927	TN

General Provider Information

NPI Number	:	1407260854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK T KIRBY D.O.

Provider Business Mailing Address
First Line	:	18511 HIGHLANDER MEDICS ST
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79906-5327
Country	:	US
Telephone Number	:	915-742-0296
Fax Number	:	915-569-0725

Provider Business Practice Location Address
First Line	:	650 JOEL DR
Second Line	:	BLANCHFIELD ARMY COMMUNITY HOSPITAL
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-461-4793
Fax Number	:	270-412-4151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/03/2026

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