Provider Demographics
NPI:1497948004
Name:JOEL HORNUNG & LORA SIEGLE PTR
Entity Type:Organization
Organization Name:JOEL HORNUNG & LORA SIEGLE PTR
Other - Org Name:FAMILY HEALTH CENTER OF MORRIS COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-767-5126
Mailing Address - Street 1:604 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1422
Mailing Address - Country:US
Mailing Address - Phone:620-767-5126
Mailing Address - Fax:620-767-6910
Practice Address - Street 1:604 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1422
Practice Address - Country:US
Practice Address - Phone:620-767-5126
Practice Address - Fax:620-767-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100209320AMedicaid
KS100002640HMedicaid
KS100208060AMedicaid
KS100205890AMedicaid
KS200427120AMedicaid
KS100002640HMedicaid
KSB69314Medicare UPIN
KS100209320AMedicaid