Provider Demographics
NPI:1033395256
Name:KENNETH W. KILGORE
Entity Type:Organization
Organization Name:KENNETH W. KILGORE
Other - Org Name:LITITZ PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-626-7666
Mailing Address - Street 1:46 COPPERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9482
Mailing Address - Country:US
Mailing Address - Phone:717-626-7666
Mailing Address - Fax:717-626-1605
Practice Address - Street 1:46 COPPERFIELD CIR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9482
Practice Address - Country:US
Practice Address - Phone:717-626-7666
Practice Address - Fax:717-626-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004716L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50007504OtherCAPITAL BLUE CROSS
PA4782270001Medicare NSC