Provider Demographics
NPI:1063573830
Name:JONESVILLE HEALTH CARE PLLC
Entity type:Organization
Organization Name:JONESVILLE HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-849-7100
Mailing Address - Street 1:216 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1128
Mailing Address - Country:US
Mailing Address - Phone:517-849-7100
Mailing Address - Fax:517-849-2453
Practice Address - Street 1:216 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1128
Practice Address - Country:US
Practice Address - Phone:517-849-7100
Practice Address - Fax:517-849-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114516211Medicaid
MI0153000175OtherBLUE CROSS
MI143119OtherGREAT LAKES
MI7559446OtherAETNA
MIP117885OtherBCN
MI0120255OtherPHP
MI0120256OtherPHP
MI7537437OtherAETNA
MI0153000155OtherBLUE CROSS
MI114511135Medicaid
MIP30270FOtherBCN
MI143115OtherGREAT LAKES
MI0120255OtherPHP
MI114511135Medicaid
MI0153000155OtherBLUE CROSS
MIP30270FOtherBCN
MI7559446OtherAETNA