Provider Demographics
NPI:1659364008
Name:GEORGE KINGSLEY, D.O., INC.
Entity Type:Organization
Organization Name:GEORGE KINGSLEY, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:972-875-1912
Mailing Address - Street 1:2203 W. LAMPASAS ST.
Mailing Address - Street 2:SUITE#106
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-2490
Mailing Address - Country:US
Mailing Address - Phone:972-875-1912
Mailing Address - Fax:972-875-1913
Practice Address - Street 1:2203 W. LAMPASAS ST.
Practice Address - Street 2:SUITE#106
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-2490
Practice Address - Country:US
Practice Address - Phone:972-875-1912
Practice Address - Fax:972-875-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1837207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID#