Provider Demographics
NPI:1407969520
Name:DAVID L. KYLE, JR., M.D.
Entity Type:Organization
Organization Name:DAVID L. KYLE, JR., M.D.
Other - Org Name:CORNERSTONE FAMILY MEDICINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-261-8000
Mailing Address - Street 1:801 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4070
Mailing Address - Country:US
Mailing Address - Phone:864-261-8000
Mailing Address - Fax:864-224-1514
Practice Address - Street 1:801 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4070
Practice Address - Country:US
Practice Address - Phone:864-261-8000
Practice Address - Fax:864-224-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0986Medicaid
SC4585Medicare PIN