| William D. Kirk M.d., Pllc | |
|
312 W High St Lebanon KY 40033-1428 | |
| (270) 692-9559 | |
| (270) 692-9236 |
| Full Name | William D. Kirk M.d., Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 312 W High St, Lebanon, Kentucky |
| Authorized Official Name and Position | William Deadrick Kirk (OWNER) |
| Authorized Official Contact | 2706929559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| William D. Kirk M.d., Pllc 312 W High St Lebanon KY 40033-1428 Ph: (270) 692-9559 | William D. Kirk M.d., Pllc 312 W High St Lebanon KY 40033-1428 Ph: (270) 692-9559 |
| NPI Number | 1417043886 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 10/06/2015 |
| Medicare PECOS PAC ID | 3173794740 |
|---|---|
| Medicare Enrollment ID | O20110913000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417043886 | NPI | - | NPPES |
| 9590111200 | Medicaid | KY | |
| 50001390 | Other | KY | PASSPORT |
| 2442987001 | Other | KY | PASSPORT ADVANTAGE |
| 78903242 | Medicaid | KY |
| Provider Name | William D Kirk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972595270 PECOS PAC ID: 0446245096 Enrollment ID: I20040415000003 |
| Provider Name | Abigail H Southall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861006066 PECOS PAC ID: 0244659209 Enrollment ID: I20200924003293 |
| Provider Name | Abigail P Smothers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053020651 PECOS PAC ID: 0446620421 Enrollment ID: I20230109001732 |
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