| Kenan Kirkendall, D.o., Pc | |
|
1501 Main St Woodward OK 73801-3043 | |
| (580) 254-5316 | |
| (580) 256-6508 |
| Full Name | Kenan Kirkendall, D.o., Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1501 Main St, Woodward, Oklahoma |
| Authorized Official Name and Position | Kenan Kirkendall (PHYSICIAN) |
| Authorized Official Contact | 5802545316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenan Kirkendall, D.o., Pc 1501 Main St Woodward OK 73801-3043 Ph: (580) 254-5316 | Kenan Kirkendall, D.o., Pc 1501 Main St Woodward OK 73801-3043 Ph: (580) 254-5316 |
| NPI Number | 1396890034 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 09/27/2012 |
| Medicare PECOS PAC ID | 5991966590 |
|---|---|
| Medicare Enrollment ID | O20120406000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396890034 | NPI | - | NPPES |
| 100256120A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Kenan L Kirkendall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316949563 PECOS PAC ID: 7214068857 Enrollment ID: I20100626000119 |
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