1982826855 NPI number — JONATHAN M JONES D.O.

Table of content: JONATHAN M JONES D.O. (NPI 1982826855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982826855 NPI number — JONATHAN M JONES D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JONATHAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1982826855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 DEMOSS STREET
Provider Second Line Business Mailing Address:
HIDALGO MEDICAL SERVICES
Provider Business Mailing Address City Name:
LORDSBURG
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88045-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-542-8384
Provider Business Mailing Address Fax Number:
575-542-8367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 W. 11TH STREET
Provider Second Line Business Practice Location Address:
HMS MED SQUARE CLINIC
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-388-1511
Provider Business Practice Location Address Fax Number:
575-542-8367
Provider Enumeration Date:
05/02/2007

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: 208000000X , with the licence number:  4615 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: A-1692-12 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NMA1029998 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 53286758 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".