1912123324 NPI number — DANNY DALE JONES

Table of content: (NPI 1912123324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912123324 NPI number — DANNY DALE JONES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANNY DALE JONES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOMETOWN OXYCARE
Provider Other Organization Name Type Code:
3
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:
1912123324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1034
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38281-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-886-0601
Provider Business Mailing Address Fax Number:
731-884-0950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38261-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-886-0601
Provider Business Practice Location Address Fax Number:
731-884-0950
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
731-886-0601

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0000000694 , 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: 4071089 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com