1306831144 NPI number — ROBERT R JONES MD

Table of content: ROBERT R JONES MD (NPI 1306831144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306831144 NPI number — ROBERT R JONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
ROBERT
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
RILEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306831144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6077 PRIMACY PKWY STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-725-8347
Provider Business Mailing Address Fax Number:
901-259-7637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 KATE BOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLETT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-381-4664
Provider Business Practice Location Address Fax Number:
901-373-3804
Provider Enumeration Date:
09/19/2005

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: 207X00000X , with the licence number:  MD0000007980 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 7980 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2602432 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88440 . This is a "BC" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 40MD0007890 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4228315 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7109 . This is a "BC" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00759329 . This is a "MEDICARE RR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 106948001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1514477 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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