Provider Demographics
NPI:1013964949
Name:KINNEY, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:KINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1934
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:88 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-0060
Practice Address - Fax:740-446-5154
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0554798Medicaid
OH310917085030OtherOH MEDICAID CARESOURCE
OH0554798OtherMOLINA MEDICAID
930058712OtherRR MEDICARE
WV0048314000Medicaid
000000185220OtherUNISON MEDICAID
000000477252OtherANTHEM BCBS
001714101OtherMOUNTAIN STATE BCBS
930058712OtherRR MEDICARE
OH310917085030OtherOH MEDICAID CARESOURCE