1427099886 NPI number — JOSEPH A. KINGSBURY, D.O.,PC

Table of content: (NPI 1427099886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427099886 NPI number — JOSEPH A. KINGSBURY, D.O.,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH A. KINGSBURY, D.O.,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427099886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 GENESYS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-606-7190
Provider Business Mailing Address Fax Number:
810-606-7186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 GENESYS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-606-7190
Provider Business Practice Location Address Fax Number:
810-606-7186
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KINGSBURY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-606-7190

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1761231 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4073348 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160B511630 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1652511805 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1652530285 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2760703 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4928770 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01003097 . This is a "HEALTHPLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0230285 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160B511630 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2760703 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C2896 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E26094 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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