Active NPI
Lance W. Kirkegaard, MD
- Internal Medicine Physician
- Tacoma, WA
National Provider Identifier
1679693311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00026688
- Practice address
- 1717 S J St
Tacoma, WA 98405-4933 - Phone
- (253) 426-6341
- Fax
- (253) 426-6344
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00026688 | WA | Primary |
Addresses
Primary practice location
1717 S J St
Tacoma, WA 98405-4933
Mailing address
1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0127104 | Other | WA | STATE L&I |
| 1054667 | Medicaid | WA | |
| 8902544 | Other | WA | STATE CRIME VICTIMS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289865600000",
"number": "1679693311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 S J ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054933",
"telephone_number": "253-426-6341",
"fax_number": "253-426-6344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 S J ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054933",
"telephone_number": "253-426-6341",
"fax_number": "253-426-6344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKEGAARD",
"first_name": "LANCE",
"middle_name": "W.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2010-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00026688",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0127104",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1054667",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8902544",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.