Provider Demographics
NPI:1790194009
Name:JONESVILLE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:JONESVILLE HEALTHCARE PLLC
Other - Org Name:JONESVILLE HEALTHCARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-849-7166
Mailing Address - Street 1:216 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1128
Mailing Address - Country:US
Mailing Address - Phone:517-849-7166
Mailing Address - Fax:517-849-7126
Practice Address - Street 1:216 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1128
Practice Address - Country:US
Practice Address - Phone:517-849-7166
Practice Address - Fax:517-849-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid
MI238927Medicare Oscar/Certification