Provider Demographics
NPI:1639325111
Name:JOE V KILPATRICK, M.D.P.C.
Entity Type:Organization
Organization Name:JOE V KILPATRICK, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-591-0595
Mailing Address - Street 1:3355 N ACADEMY BLVD
Mailing Address - Street 2:PMB 118
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5103
Mailing Address - Country:US
Mailing Address - Phone:719-591-0595
Mailing Address - Fax:719-591-0638
Practice Address - Street 1:3229 W CAREFREE CIR
Practice Address - Street 2:BLDG G
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3004
Practice Address - Country:US
Practice Address - Phone:719-591-0595
Practice Address - Fax:719-591-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017521Medicaid
CO279692Medicare UPIN