1053437061 NPI number — ROSE M MALONE-JONES CNS

Table of content: ROSE M MALONE-JONES CNS (NPI 1053437061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053437061 NPI number — ROSE M MALONE-JONES CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALONE-JONES
Provider First Name:
ROSE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053437061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 CEDAR BARK TRL UNIT 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CARROLLTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45449-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-751-6742
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-461-0800
Provider Business Practice Location Address Fax Number:
937-496-0171
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SC1501X , with the licence number:  NS-08913 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3047689 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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