MEDICARE: JAMES M KIRBY AND JOSEPH J FEDORCHIK

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1861561623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES M KIRBY AND JOSEPH J FEDORCHIK

Provider Business Mailing Address
First Line	:	2700 E 29TH ST
Second Line	:	SUITE 240
City	:	BRYAN
State	:	TX
Zip	:	77802-2531
Country	:	US
Telephone Number	:	979-776-0750
Fax Number	:	979-774-0001

Provider Business Practice Location Address
First Line	:	2700 E 29TH ST
Second Line	:	SUITE 240
City	:	BRYAN
State	:	TX
Zip	:	77802-2531
Country	:	US
Telephone Number	:	979-776-0750
Fax Number	:	979-774-0001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES M. KIRBY
Credential	:	M.D.
Telephone Number	:	979-776-0750

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	01/19/2010

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