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NPI Code Detail

MEDICARE: HAROLD KILGORE

MEDICARE: HAROLD KILGORE
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
1385HR2055XChild Mental Illness Respite Care7470789AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17470789OTHERAZAZ DEPT OF HEALTH SERVICES

General Provider Information

NPI Number : 1972163293
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAROLD KILGORE
Provider Business Mailing Address
First Line : 3734 E LONGHORN ST
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85140-4303
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3734 E LONGHORN ST
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85140-4303
Country : US
Telephone Number : 602-321-4154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 06/18/2019

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Directions to “ HAROLD KILGORE ” Practice Location

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