Provider Demographics
NPI:1982659637
Name:JOYCE A HAISLIP, MD.,PSC
Entity Type:Organization
Organization Name:JOYCE A HAISLIP, MD.,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-852-6600
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:STE 306
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-852-6600
Mailing Address - Fax:270-852-6611
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:STE 306
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-852-6600
Practice Address - Fax:270-852-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65945099Medicaid
KY65945099Medicaid
KY00002Medicare ID - Type UnspecifiedMEDICARE