Provider Demographics
NPI:1356443477
Name:JOHN KILGALLIN M.D.
Entity Type:Organization
Organization Name:JOHN KILGALLIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-866-3161
Mailing Address - Street 1:124 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4278
Mailing Address - Country:US
Mailing Address - Phone:270-866-3161
Mailing Address - Fax:270-866-3163
Practice Address - Street 1:124 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4278
Practice Address - Country:US
Practice Address - Phone:270-866-3161
Practice Address - Fax:270-866-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000202451OtherANTHEM BC/BS
KY000000049266OtherANTHEM BC/BS
KY65935983Medicaid
KY78902103Medicaid
KY000000049266OtherANTHEM BC/BS
KY65935983Medicaid