Basic Information
Provider Information | |||||||||
NPI: | 1689647596 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIRK | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | FREDERICK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 809 MITCHELL AVE | ||||||||
Address2: |   | ||||||||
City: | LEXINGTON | ||||||||
State: | NC | ||||||||
PostalCode: | 272922856 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3362362021 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 889 BRADLEY ST | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NC | ||||||||
PostalCode: | 280252979 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7047864482 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/10/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 318 | NC | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | 17585 | 01 | NC | PARTNER'S | OTHER | 890809J | 05 | NC |   | MEDICAID | 0546620001 | 01 | NC | PALMETTO | OTHER | 0804449 | 01 | NC | AETNA | OTHER | 2740943 | 01 | NC | UNITED HEALTHCARE | OTHER | 269695 | 01 | NC | MAMSI | OTHER | 95137 | 01 | NC | MEDCOST | OTHER | 012C2 | 01 | NC | BLUE CROSS BLUE SHIELD N | OTHER |