NPIMap

Organization Active NPI

Kilgore Vision Center

  • Specialist
  • Mountain Home, AR
National Provider Identifier
1447253273
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
KILGORE VISION CENTER
Practice address
2943 Highway 62 W
Mountain Home, AR 72653-6535
Phone
(870) 424-4900
Fax
(870) 424-4979
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

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

Authorized official

Name
Dr. Kenneth Merle Kilgore, MDNPI 1659374429
Title
Owner President
Phone
(870) 424-4900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2943 Highway 62 W
Mountain Home, AR 72653-6535

Mailing address

PO Box 444
Mountain Home, AR 72654-0444
Phone (870) 424-4900

Other identifiers 1

IdentifierTypeStateIssuer
1447253273OtherARNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050801001246 AR Part B Supplier - Clinic/Group Practice 0345278214 Receives reassigned benefits from 11 practitioners
Practice locations: Harrison, AR; Mountain Home, AR
O20100930073693 AR DME Supplier - Physician - OphthalmologyDME Supplier - Physician - OptometristDME Supplier - Optician 0345278214 Practice locations: Mountain Home, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kilgore Vision Center2943 Highway 62 W, Mountain Home, AR 72653-6535(870) 424-4900 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Aug 11, 1998

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1447253273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540444",
            "telephone_number": "870-424-4900",
            "fax_number": "870-424-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2943 HIGHWAY 62 W",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726536535",
            "telephone_number": "870-424-4900",
            "fax_number": "870-424-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MERLE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "870-424-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1447253273",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.