MEDICARE: JOHN A KIRKUS PA-C

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	363A00000X	Physician Assistant	PA07236	TX

General Provider Information

NPI Number	:	1679852248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A KIRKUS PA-C

Provider Business Mailing Address
First Line	:	2901 VIA FORTUNA
Second Line	:	STE 600
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-7565
Country	:	US
Telephone Number	:	512-750-0357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 VIA FORTUNA
Second Line	:	STE 600
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-7565
Country	:	US
Telephone Number	:	512-750-0357
Fax Number	:

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/04/2015

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