Provider Demographics
NPI:1710698147
Name:KIRK RENFRO, LLC
Entity Type:Organization
Organization Name:KIRK RENFRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:D
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-208-1006
Mailing Address - Street 1:110 E RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-3408
Mailing Address - Country:US
Mailing Address - Phone:501-208-1006
Mailing Address - Fax:
Practice Address - Street 1:110 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-3408
Practice Address - Country:US
Practice Address - Phone:501-208-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIRK RENFRO , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center