Provider Demographics
NPI:1952064453
Name:KINNEY, JAMES E
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 FOX DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7377
Mailing Address - Country:US
Mailing Address - Phone:217-903-3594
Mailing Address - Fax:
Practice Address - Street 1:1902 FOX DR STE 6
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7377
Practice Address - Country:US
Practice Address - Phone:217-903-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)