Provider Demographics
NPI:1346395167
Name:KIRK, NICHOLSON & REYNOLDS, L.L.P.
Entity Type:Organization
Organization Name:KIRK, NICHOLSON & REYNOLDS, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:B.J.
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-793-8787
Mailing Address - Street 1:3612 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1326
Mailing Address - Country:US
Mailing Address - Phone:806-793-8787
Mailing Address - Fax:806-793-0150
Practice Address - Street 1:3612 23RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1326
Practice Address - Country:US
Practice Address - Phone:806-793-8787
Practice Address - Fax:806-793-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCI9814OtherRAILROAD MEDICARE
TX178559401Medicaid
TX0094KPOtherBLUE CROSS/BLUE SHIELD TX
TXCI9814OtherRAILROAD MEDICARE
TX00284NMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TXI22308Medicare UPIN
TX178559401Medicaid