Basic Information
| Provider Information | |||||||||
| NPI: | 1013964949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404411934 | ||||||||
| FaxNumber: | 7404465982 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 E MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | POMEROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457699569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409920060 | ||||||||
| FaxNumber: | 7404465154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-04-6689 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0554798 | 05 | OH | MEDICAID | 310917085030 | 01 | OH | OH MEDICAID CARESOURCE | OTHER | 0554798 | 01 | OH | MOLINA MEDICAID | OTHER | 930058712 | 01 | RR MEDICARE | OTHER | 0048314000 | 05 | WV | MEDICAID | 000000185220 | 01 | UNISON MEDICAID | OTHER | 000000477252 | 01 | ANTHEM BCBS | OTHER | 001714101 | 01 | MOUNTAIN STATE BCBS | OTHER |