Provider Demographics
NPI:1255783437
Name:KINGSWAY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:KINGSWAY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ONIGBINDE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:240-565-7595
Mailing Address - Street 1:601 CORSAIR CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7749
Mailing Address - Country:US
Mailing Address - Phone:240-565-7595
Mailing Address - Fax:
Practice Address - Street 1:601 CORSAIR CT
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7749
Practice Address - Country:US
Practice Address - Phone:240-565-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCL00004609298302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization