Provider Demographics
NPI:1598732943
Name:TODD KISLINGBURY DO PA
Entity Type:Organization
Organization Name:TODD KISLINGBURY DO PA
Other - Org Name:FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:KISLINGBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-564-9090
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273
Mailing Address - Country:US
Mailing Address - Phone:903-564-9090
Mailing Address - Fax:903-564-7718
Practice Address - Street 1:308 CHARLIE DRIVE
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273
Practice Address - Country:US
Practice Address - Phone:903-564-9090
Practice Address - Fax:903-564-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160915801Medicaid
TX0002PWOtherBCBS
TX160915801Medicaid
SC4871130001Medicare NSC