Dale Anthony Kirby

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

License

2291023 Issued in OH

Practice address

62 Anderson State Road
Fayetteville, OH 45118

Phone

(937) 205-2337

Fax

(513) 875-2811

NPI assigned

Oct 10, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1063500700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 141",
            "city": "FAYETTEVILLE",
            "state": "OH",
            "postal_code": "451180141",
            "telephone_number": "937-205-2337",
            "fax_number": "513-875-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 ANDERSON STATE ROAD",
            "city": "FAYETTEVILLE",
            "state": "OH",
            "postal_code": "45118",
            "telephone_number": "937-205-2337",
            "fax_number": "513-875-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRBY",
        "first_name": "DALE",
        "middle_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "OH",
            "license": "2291023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2291023",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Modifications Contractor in Fayetteville, OH
• Providers in Fayetteville, OH by specialty
• Home Modifications Contractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.