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General NPI Number Information
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NPI Number | 1861219644
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Entity Type | Organization
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Legal Business Name | JEFFERSONVILLE INTEGRATIVE CLINIC LLC
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 300 SPRING ST STE 3C
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3385
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Country | US
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Telephone | 501-223-2776
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Fax | 501-223-2779
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Provider Business Mailing Address
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Address Line | 300 SPRING ST STE C
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3385
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Country | US
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Telephone | 501-223-2776
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Fax | 501-223-2779
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Authorized Official
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Title or Position | OWNER
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Name | RICKEY DALE KINZEY
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Credential | MD
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Telephone | 361-761-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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