Provider Demographics
NPI:1881638906
Name:KIRK L. PYLE
Entity Type:Organization
Organization Name:KIRK L. PYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-722-5575
Mailing Address - Street 1:P.O. BOX 1202
Mailing Address - Street 2:118 PUBLIC SQUARE EAST
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-1202
Mailing Address - Country:US
Mailing Address - Phone:931-722-5575
Mailing Address - Fax:931-722-5548
Practice Address - Street 1:118 PUBLIC SQUARE EAST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-1202
Practice Address - Country:US
Practice Address - Phone:931-722-5575
Practice Address - Fax:931-722-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN291U00000X293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4072906OtherBCBS
TN3791125Medicaid
TN3791125Medicare PIN