Provider Demographics
NPI:1184818221
Name:J KIRK & COMPANY P C
Entity Type:Organization
Organization Name:J KIRK & COMPANY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEBOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-272-6333
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0599
Mailing Address - Country:US
Mailing Address - Phone:918-272-6333
Mailing Address - Fax:918-272-6777
Practice Address - Street 1:10512 N 110TH EAST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6636
Practice Address - Country:US
Practice Address - Phone:918-622-8513
Practice Address - Fax:918-622-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3269208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG28248Medicare UPIN
OK200522155Medicare PIN