NPIMap

Organization Active NPI

Kirk Medical Clinic

  • General Practice Physician
  • Benton, AR
National Provider Identifier
1982811543
Registry record updated Nov 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
C4039 Issued in AR
Legal business name
KIRK MEDICAL CLINIC
Practice address
1102 West South St Suite B
Benton, AR 72015
Phone
(501) 776-8545
Fax
(501) 776-1619
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2010

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

Authorized official

Name
Marvin N. Kirk, M.D.
Title
Owner
Phone
(501) 776-8545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X C4039 AR Primary

Addresses

Primary practice location

1102 West South St Suite B
Benton, AR 72015

Mailing address

1102 West South St Suite B
Benton, AR 72015
Phone (501) 776-8545

National Provider Directory

National Provider Directory

Locations

1102 W South St
Ste B
Benton, AR 72015
Phone (501) 776-8545

1102 W South St
#B
Benton, AR 72015
Phone (501) 775-6854

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1982811543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 WEST SOUTH ST SUITE B",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-776-8545",
            "fax_number": "501-776-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WEST SOUTH ST SUITE B",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "72015",
            "telephone_number": "501-776-8545",
            "fax_number": "501-776-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRK MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-776-8545",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "C4039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.

Verify at the official NPI Registry.