Provider Demographics
NPI:1427136472
Name:JOANNE KINGSLEY MD PLLC
Entity type:Organization
Organization Name:JOANNE KINGSLEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-796-4775
Mailing Address - Street 1:1931 HORTON RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5594
Mailing Address - Country:US
Mailing Address - Phone:517-782-7510
Mailing Address - Fax:517-782-7520
Practice Address - Street 1:1931 HORTON RD
Practice Address - Street 2:SUITE 8
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5594
Practice Address - Country:US
Practice Address - Phone:517-782-7510
Practice Address - Fax:517-782-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0720045OtherPHP PROVIDER NUMBER
MI104778547Medicaid
MI1603811241OtherBCBS PROVIDER NUMBER
MI104778547Medicaid
MI0720045OtherPHP PROVIDER NUMBER
MI1603811241OtherBCBS PROVIDER NUMBER