Provider Demographics
NPI:1023289188
Name:JOHN J KIRKLAND MD PA
Entity type:Organization
Organization Name:JOHN J KIRKLAND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-662-8468
Mailing Address - Street 1:110 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4712
Mailing Address - Country:US
Mailing Address - Phone:843-662-8468
Mailing Address - Fax:843-662-8469
Practice Address - Street 1:110 W PINE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4712
Practice Address - Country:US
Practice Address - Phone:843-662-8468
Practice Address - Fax:843-662-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC064012Medicaid
SC=========OtherTAX ID
SC2368Medicare PIN
SCC60711Medicare UPIN